Article Text
Abstract
Introduction South Africa experiences significant levels of alcohol-related harm. Recent research suggests minimum unit pricing (MUP) for alcohol would be an effective policy, but high levels of income inequality raise concerns about equity impacts. This paper quantifies the equity impact of MUP on household health and finances in rich and poor drinkers in South Africa.
Methods We draw from extended cost-effectiveness analysis (ECEA) methods and an epidemiological policy appraisal model of MUP for South Africa to simulate the equity impact of a ZAR 10 MUP over a 20-year time horizon. We estimate the impact across wealth quintiles on: (i) alcohol consumption and expenditures; (ii) mortality; (iii) government healthcare cost savings; (iv) reductions in cases of catastrophic health expenditures (CHE) and household savings linked to reduced health-related workplace absence.
Results We estimate MUP would reduce consumption more among the poorest than the richest drinkers. Expenditure would increase by ZAR 353 000 million (1 US$=13.2 ZAR), the poorest contributing 13% and the richest 28% of the increase, although this remains regressive compared with mean income. Of the 22 600 deaths averted, 56% accrue to the bottom two quintiles; government healthcare cost savings would be substantial (ZAR 3.9 billion). Cases of CHE averted would be 564 700, 46% among the poorest two quintiles. Indirect cost savings amount to ZAR 51.1 billion.
Conclusions A MUP policy in South Africa has the potential to reduce harm and health inequality. Fiscal policies for population health require structured policy appraisal, accounting for the totality of effects using mathematical models in association with ECEA methodology.
- public health
- epidemiology
- health economics
- mathematical modelling
- health policy
Data availability statement
Data may be obtained from a third party and are not publicly available. All data sources used in the model are listed in the web appendix. Data may be obtained from a thrid party and are not publically available
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
Data may be obtained from a third party and are not publicly available. All data sources used in the model are listed in the web appendix. Data may be obtained from a thrid party and are not publically available
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Handling editor Lei Si
Contributors NG, with the help of all authors, conceptualised the study. NG completed the modelling under the supervision of CA and SV. MKB provided data inputs for the model. NG wrote the first draft, all authors revised it. An earlier version of this paper was presented at the meeting of the International Health Economics Association (2021), the KBS Alcohol Epidemiology conference (2021) and at the York Centre for Health Economics seminar series (2021), where we received valuable comments from participants. NG is the author acting as guarantor.
Funding This research was funded in part, by the Wellcome Trust (108903/B/15/Z). For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. It was also funded by the University of Sheffield and the South African Medical Research Council. PSM is also funded by UK Medical Research Council and Chief Scientist Office grants MC_UU_00022/5 and SPHSU 20. MKB is supported by SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SA (grant number 23108). SV acknowledges funding support from the Trond Mohn Foundation and NORAD through BCEPS (#813596). The funders of the study had no role in the study. All authors had full access to all the data in the study and were responsible for the decision to submit the article for publication.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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