Impact of minimum price per unit of alcohol on patients with liver disease in the UK

Abstract

The slow epidemic of liver disease in the UK over the past 30 years is a result of increased consumption of strong cheap alcohol. When we examined alcohol consumption in 404 subjects with a range of liver disease, we confirmed that patients with alcohol-related cirrhosis drank huge amounts of cheap alcohol, with a mean weekly consumption of 146 units in men and 142 in women at a median price of 33p/unit compared with £1.10 for low-risk drinkers. For the patients in our study, the impact of a minimum unit price of 50p/unit on spending on alcohol would be 200 times higher for patients with liver disease who were drinking at harmful levels than for low-risk drinkers. As a health policy, a minimum unit price for alcohol is exquisitely targeted at the heaviest drinkers, for whom the impact of alcohol-related illness is most devastating.

Keywords: Alcohol; alcohol policy; cirrhosis; liver; minimum unit price.

Fig 1.

Preferences for different types of alcoholic beverage vary -between low-risk and harmful drinkers in (a) The proportions of total units -consumed as: spirits, cider, wine and according to the category of drinking hazard. (b) Units of alcohol of consumed per week by males according to type of alcohol and category of drinking hazard. (c) Units of alcohol of consumed per week by females according to type of alcohol and category of drinking hazard. As a proportion of alcohol consumed, harmful drinkers drank twice as much alcohol as spirits (p = 0.002) and three times as much alcohol as cider (p < 0.001) compared with low-risk drinkers. The proportion of alcohol drunk as wine was reduced in harmful drinkers (p < 0.001), although women drinking at harmful levels consumed equivalent proportions of their alcohol intake as wine (30%) and spirits (30%).

Fig 2.

Mean (95% confidence interval; p < 0.001) additional cost of a minimum unit price (MUP) of 50p for alcohol according to category of drinking grade. With knowledge of the amount of alcohol consumed and the price paid per unit for each subject, we were able to estimate the additional cost for each category of drinker should an MUP of 50p/unit be imposed. Most low-risk and hazardous drinkers would be unaffected by an MUP of 50p/unit, and there is a massively disproportionate impact of more than 200-fold on harmful drinkers with liver disease compared with low-risk drinkers.

Fig 3.

Additional weekly cost of a minimum unit price (MUP) of 50p for alcohol categorised by risk category and income. Impact of an MUP of 50p is categorised: low-risk patients are almost entirely unaffected; some hazardous drinkers would pay up to an additional £5/week, with more impact on lower-income drinkers; and there is a disproportionate impact on harmful drinkers irrespective of income, with many of the very heavy drinkers paying more than £20/week extra.