The Social Costs of Alcohol in Sweden 2002 Pia Johansson Johan Jarl Antonina Eriksson Mimmi Eriksson Ulf-G. Gerdtham Örjan Hemström Klara Hradilova Selin Leif Lenke Mats Ramstedt Robin Room SoRAD – Forskningsrapport nr 36 – 2006 SoRAD Social Research on Alcohol and Drugs Stockholm University Sveaplan SE-106 91 Stockholm www.sorad.su.se The Social Costs of Alcohol in Sweden 2002 Pia Johansson, Johan Jarl, Antonina Eriksson, Mimmi Eriksson, Ulf-G. Gerdtham, Örjan Hemström, Klara Hra- dilova Selin, Leif Lenke, Mats Ramstedt & Robin Room © Pia Johansson, Johan Jarl, Antonina Eriksson, Mimmi Eriksson, Ulf-G. Gerdtham, Örjan Hemström, Klara Hradilova Selin, Leif Lenke, Mats Ramstedt & Robin Room SoRAD – Forskningsrapport nr 36 – 2006 The report is also available at www.sorad.se SoRADs rapportserie ISSN 1650-5441 ISBN 91-976098-5-4 Tryckt av Universitetsservice AB, 2006 ii Acknowledgements Thanks to Kerstin Damström-Thakker and Susanne Wicks (Stockholm Centre for Public Health) for producing Swedish prevalence figures of alcohol dependence for this study. We also thank Bengt Kron and Sylvia Larsson (Västra Götalandsregionen) for help with interpretation of outpatient and primary care data sets and to Torbjörn Hermansson at Region Skåne for inpatient care data set. Special thanks are due to a number of people who advised on the study. These included Dag Rekve, who served as the WHO-Euro liaison, and Patrik Nylander, the main liaison from the Swedish Department of Health and Social Affairs. Members of the international reference group for the study participated in two main advisory meetings, and several gave extensive and very helpful comments on two drafted versions of the report. The members of the reference group are: Christine Godfrey, York University; Pierre Kopp, Sorbonne University; Jacek Moskalewicz, Institute of Psychology & Neurology, War- saw; and Jürgen Rehm, Centre for Addiction & Mental Health, Toronto. Other participants in project advisory meetings -- Esa Österberg, STAKES, Helsinki; Peter Allebeck, Stockholm Centre for Public Health; and Pia Rosenqvist, Nordic Council for Alcohol & Drug Research -- also provided helpful comments. Besides serving as a member of the international reference group, Dr. Rehm also made some calculations and gave continuing advice as the study proceeded, for which we are very grateful. iii Contents 1. INTRODUCTION............................................................................................................................ 7 1.1 Purpose and scope of study...................................................................................................................................... 7 1.2 The Swedish Costs of Alcohol .................................................................................................................................. 8 1.3 Cost items included in the study ............................................................................................................................... 8 1.3.1 Health care costs .............................................................................................................................................. 9 1.3.2 Social services .................................................................................................................................................. 9 1.3.3 Crime................................................................................................................................................................. 9 1.3.4 Research, policy and prevention .................................................................................................................... 10 1.3.5 Productivity costs ............................................................................................................................................ 10 1.3.6 Intangible costs............................................................................................................................................... 11 1.3.7 Summary......................................................................................................................................................... 11 2. BACKGROUND TO COST-OF-ALCOHOL STUDIES ...................................................................... 12 2.1 Cost-of-illness studies ............................................................................................................................................. 12 2.2 The counterfactual scenario.................................................................................................................................... 13 2.3 The four steps: identify, quantify, value and discount the costs ............................................................................. 13 2.4 Direct, indirect and intangible costs ........................................................................................................................ 14 2.4.1 The direct costs............................................................................................................................................... 14 2.4.2 The indirect costs............................................................................................................................................ 14 2.4.3 The Intangible costs........................................................................................................................................ 15 2.5 Deadweight losses .................................................................................................................................................. 15 2.6 Top-down or bottom-up calculations....................................................................................................................... 16 2.7 Prevalence-based or incidence-based costs .......................................................................................................... 16 2.8 Costs included: social costs vs. transfer costs........................................................................................................ 16 2.9 Costs included: private vs. social, internal vs. external .......................................................................................... 17 2.10 Protective effects of alcohol: gross vs. net social cost.......................................................................................... 17 2.11 Calculation of the Alcohol Attributable Fraction .................................................................................................... 19 2.12 Some previous Cost-of-alcohol studies ................................................................................................................ 19 2.13 The purpose of Cost-of-alcohol studies ................................................................................................................ 19 3. BACKGROUND DATA ...................................................................................................................... 22 3.1 Age groups .............................................................................................................................................................. 22 3.2 Estimated prevalence of different levels of alcohol consumption ........................................................................... 23 3.2.1 The consumption categories........................................................................................................................... 23 3.2.2 Prevalence in the adult population, 16-79 years old: The Monitoring study 2002 ......................................... 23 3.2.3 Weighting down the proportion of abstainers by Monitoring study data from 2004 ....................................... 24 3.2.4 The young and the old .................................................................................................................................... 25 3.2.5 Estimating population size for each consumption group................................................................................ 27 3.3. Disease and injury risks ......................................................................................................................................... 27 3.3.1 Chronic disease risks...................................................................................................................................... 27 3.3.2 Injury risks....................................................................................................................................................... 29 3.3.3 Motor vehicle accidents .................................................................................................................................. 31 3.3.4 Homicide ......................................................................................................................................................... 33 4. METHODS AND MATERIAL............................................................................................................. 34 4.1 Health care costs..................................................................................................................................................... 34 ii 4.1.1 Inpatient care .................................................................................................................................................. 34 4.1.2 Outpatient and primary care ........................................................................................................................... 35 4.1.3 Total gross