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The European Journal of Public Health Advance Access published online on March 25, 2007
The European Journal of Public Health, doi:10.1093/eurpub/ckm017
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© The Author 2007. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

A cost-effectiveness analysis of alcohol prevention targeting licensed premises

Anna M. Månsdotter1,2, Malin K. Rydberg1, Eva Wallin2, Lars A. Lindholm1,3 and Sven Andréasson1,2

1 Swedish National Institute of Public Health, SE-103 52 Stockholm, Sweden
2 Karolinska Institutet, Department of Public Health Science, Division of Social Medicine, SE-171 76 Stockholm, Sweden
3 Umeå University, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences, SE-901 85 Umeå, Sweden

Correspondence: Anna Månsdotter, Swedish National Institute of Public Health, SE-103 52 Stockholm, Sweden, tel: +46 8 566 135 00, fax: +46 8 566 135 05.

Background: A multi-component alcohol prevention programme targeting licenced premises has been ongoing in Stockholm since 1996. An earlier study has established that this led to a 29% reduction in police-reported violence. The objective of the present study is to calculate the programme's cost-effectiveness from a societal perspective; the cost of implementation, the savings made as a result of fewer assaults, unlawful threats and violence towards officials, and the health gains in terms of quality-adjusted life-years (QALYs). Methods: The costs included administration, studies of alcohol serving practices, community mobilization, responsible beverage service training and stricter alcohol law enforcement. For the purpose of estimating how the decrease in violence affected savings and health gains, a survey among victims of violence (N = 604) was performed. Results: The cost of the programme was estimated at Euro 796 000. The average cost of a violent crime was estimated at Euro 19 049, which implies overall savings of Euro 31.314 million related to the judicial system (78%), production losses (15%), health care issues (5%) and other damages (2%). Accordingly, the base case cost-saving ratio was 1 : 39. The average loss of health state weighting among the victims at 0.09 translates into 236 gained QALYs for society as a whole, which should be compared with the modest proportion of savings in the health sector. Conclusion: The most significant concern is the low response rate (35%), and caution needs to be exercised when interpreting our results. Yet, a reasonable conclusion is that the monetary and human benefits have been considerable.

Keywords: alcohol, cost-effectiveness, prevention, violence


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