What are the Economic Costs to Society Attributable to Alcohol Use? A Systematic Review and Modelling Study

Abstract

Background: Alcohol-attributable costs to society are captured by cost-of-illness studies, however estimates are often not comparable, e.g. due to the omission of relevant cost components. In this contribution we (1) summarize the societal costs attributable to alcohol use, and (2) estimate the total costs under the assumption that all cost components are considered.

Methods: A systematic review and meta-analyses were conducted for studies reporting costs from alcohol consumption for the years 2000 and later, using the EMBASE and MEDLINE databases. Cost estimates were converted into 2019 international dollars (Int$) per adult and into percentage of gross domestic product (GDP). For each study, weights were calculated to correct for the exclusion of cost indicators.

Results: Of 1708 studies identified, 29 were included, and the mean costs of alcohol use amounted to 817.6 Int$ per adult (95% confidence interval [CI] 601.8-1033.4), equivalent to 1.5% of the GDP (95% CI 1.2-1.7%). Adjusting for omission of cost components, the economic costs of alcohol consumption were estimated to amount to 1306 Int$ per adult (95% CI 873-1738), or 2.6% (95% CI 2.0-3.1%) of the GDP. About one-third of costs (38.8%) were incurred through direct costs, while the majority of costs were due to losses in productivity (61.2%).

Discussion: The identified cost studies were mainly conducted in high-income settings, with high heterogeneity in the employed methodology. Accounting for some methodological variations, our findings demonstrate that alcohol use continues to incur a high level of cost to many societies.

Registration: PROSPERO #CRD42020139594.

Fig. 1

Total costs presented in 2019 international dollars per adult (size of the data point represents study weight, with a larger size indicating inclusion of more relevant cost components). EU 28 all countries of the European Union and the UK)

Fig. 2

Distribution of total costs per study for all studies that provided direct and indirect cost estimates (the vertical dashed line indicates the mean share of direct costs across all studies: 38.8%)

Fig. 3

Distribution of direct costs for all studies that provided direct cost estimates

Fig. 4

Distribution of indirect costs for all studies that provided indirect cost estimates (i.e. studies that incompletely reported the distribution of indirect costs were excluded from this plot)