WHAT ARE THE COSTS OF ALCOHOL PROBLEMS FOR HOSPITALS IN SCOTLAND

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WHAT ARE THE COSTS OFALCOHOL PROBLEMS
FORHOSPITALS IN SCOTLAND?

• Dr Julian F Guest
• C A T A L Y S T
• Health Economics Consultants Ltd
• February 2003

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CONTEXT

• Hospital costs were estimated as part of a larger
  study assessing the annual socioeconomic burden
  imposed by alcohol misuse on Scottish society
  i.e.
• Scottish NHS
• Social work services
• Criminal justice system and emergency services
• Wider costs due to lost productivity
• Human costs arising from premature mortality
• Study published in PharmacoEconomics 2002
  20(13) 891-907

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HOSPITALISATION (1)

• Data were obtained from the inpatient databases
  of the Information and Statistics division of the
  NHS in Scotland which consists of data from all
  Scottish NHS Trusts
• Data were obtained on
• Non-psychiatric episodes directly due to alcohol
  misuse for the year ending March 2000 e.g. liver
  disease
• Psychiatric episodes directly due to alcohol
  misuse for the year ending March 1999 - which was
  the most recent data available e.g. dependence
  syndrome

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HOSPITALISATION (2)

• The annual number of inpatient episodes
  indirectly due to alcohol misuse was also
  estimated for individuals with other conditions
  where the incidence of alcohol misuse is raised,
  such as
• Cardiovascular diseases
• Hepatic diseases
• Cancers
• Injuries as a result of alcohol misuse

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HOSPITALISATION (3)
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ANNUAL NUMBER OF HOSPITAL ADMISSIONS BY AGE
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ANNUAL NUMBER OF HOSPITAL ADMISSIONS PER 10,000
POPULATION BY AGE
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ANNUAL NUMBER OF BED DAYS IN SCOTLAND DUE TO
ALCOHOL MISUSE BY AGE
9
HOSPITALISATION PER 10,000 POPULATION BY
DEPRIVATION
10
BED DAYS PER 10,000 POPULATION BY DEPRIVATION
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ANNUAL NUMBER OF HOSPITALISATIONS DUE TO ALCOHOL
MISUSE BY HEALTH BOARD
12
HOSPITALISATIONS PER 10,000 POPULATION DUE TO
ALCOHOL MISUSE BY HEALTH BOARD
13
HOSPITALISATIONS BY PRIMARY REASON
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HOSPITALISATION (4)

• Hospitalisation arising from
• Maternal care for suspected damage to the foetus
  from alcohol
• Foetus and newborn affected by maternal use of
  alcohol
• Foetal alcohol syndrome
• have not been included in the analysis due to
  severe under-reporting in the relevant databases
  held by the Information and Statistics Division

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OTHER HOSPITAL COSTS (1)

• Using published data, we estimated resource
  utilisation attributable to alcohol misuse by
  patients using
• Accident and emergency departments
• Outpatient services
• NHS day hospitals
• Sources
• ISD, Scotland 2000
• Scottish Healthcare Costs, 2000
• Pirmohamed et al. Qtr J Med 2000 933 291-5

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OTHER HEALTHCARE COSTS (2)
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TOTAL ANNUAL NHS SCOTLAND COST OF ALCOHOL MISUSE
IN SCOTLAND
Total annual healthcare cost 95.6 million
Annual healthcare cost ( million)
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DISTRIBUTION OF TOTAL HEALTH SERVICE COSTS
Total annual healthcare cost 95.6m
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TOTAL ANNUAL SOCIETAL COST
Total annual societal cost of alcohol misuse
1,071m
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SUMMARY (1)

• Alcohol misuse imposes a greater burden on the
  criminal justice system than both the health
  service and social services
• However, the greatest burden is on the individual
  and society as a whole in terms of lost
  productivity arising from unemployment,
  absenteeism from work and premature mortality

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SUMMARY (2)

• The level of indirect cost is consistent with the
  burden on the health service, since it is those
  of working age who have more alcohol-related GP
  consultations and hospital admissions than those
  in other age groups
• Alcohol-related hospital admissions are higher
  among those who are from more deprived
  backgrounds
• May also be consistent with our finding that an
  estimated 24 of children and families social
  work case load is alcohol-related

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SUMMARY (3)

• Alcohol consumption is increasing among those
  aged 11-15 years
• This is reflected in another finding that there
  is an increasing number of referrals to the
  Children's Hearing System for substance (drug and
  alcohol) misuse
• Additionally, there were 486 non-psychiatric
  hospital admissions by those under 16 years
  directly due to alcohol in 1999/2000

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SUMMARY (4)

• The health boards which have the greatest number
  of alcohol-related hospital admissions are
  Greater Glasgow, Argyll and Clyde, Lothian and
  Lanarkshire, Grampian and Ayr and Arran
• This is concordant with local authorities which
  incur the greatest expenditure on community care
  services in total and per capita for drug and
  alcohol misuse
• It also reflects the areas that have the highest
  levels of alcohol consumption for both men and
  women
• Service use may only be an indication of service
  provision and not be informative about service
  requirements

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CONCLUSIONS (1)

• Alcohol misuse imposes a substantial burden on
  Scottish society, costing an estimated 1,071
  million per year at 2001/2002 prices
• 38 is due to wider economic costs
• 25 is due to the criminal justice system
• 20 is due to human costs
• 9 is due to NHS Scotland of which 57 is due to
  hospitalisations
• 8 is due to social work services

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CONCLUSIONS (2)

• The costs estimated in the study often reflect
  past levels of resource use
• Cost of illness studies such as this provide
  information about patterns of resource use
  associated with a particular condition, thereby
  enabling a greater understanding of the framework
  in which decisions about resource allocation are
  made
• However, cost of illness studies, unlike cost
  effectiveness and cost utility studies, are
  unable to directly inform decisions about whether
  resource allocation for particular treatments or
  strategies are effective