title: Cost-effectiveness of preventive interventions to reduce alcohol consumption in Denmark.
abstract: BACKGROUND
  Excessive alcohol consumption increases the risk of many diseases and injuries, and the Global Burden of Disease 2010 study estimated that 6% of the burden of disease in Denmark is due to alcohol consumption. Alcohol consumption thus places a considerable economic burden on society.
  
  
  METHODS
  We analysed the cost-effectiveness of six interventions aimed at preventing alcohol abuse in the adult Danish population: 30% increased taxation, increased minimum legal drinking age, advertisement bans, limited hours of retail sales, and brief and longer individual interventions. Potential health effects were evaluated as changes in incidence, prevalence and mortality of alcohol-related diseases and injuries. Net costs were calculated as the sum of intervention costs and cost offsets related to treatment of alcohol-related outcomes, based on health care costs from Danish national registers. Cost-effectiveness was evaluated by calculating incremental cost-effectiveness ratios (ICERs) for each intervention. We also created an intervention pathway to determine the optimal sequence of interventions and their combined effects.
  
  
  RESULTS
  Three of the analysed interventions (advertising bans, limited hours of retail sales and taxation) were cost-saving, and the remaining three interventions were all cost-effective. Net costs varied from € -17 million per year for advertisement ban to € 8 million for longer individual intervention. Effectiveness varied from 115 disability-adjusted life years (DALY) per year for minimum legal drinking age to 2,900 DALY for advertisement ban. The total annual effect if all interventions were implemented would be 7,300 DALY, with a net cost of € -30 million.
  
  
  CONCLUSIONS
  Our results show that interventions targeting the whole population were more effective than individual-focused interventions. A ban on alcohol advertising, limited hours of retail sale and increased taxation had the highest probability of being cost-saving and should thus be first priority for implementation.
authors: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors: Astrid Ledgaard
authors: AL
authors: Holm
authors: School of Population Health, The University of Queensland, Brisbane, Australia.
authors: Lennert
authors: L
authors: Veerman
authors: School of Population Health, The University of Queensland, Brisbane, Australia.
authors: Linda
authors: L
authors: Cobiac
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors: Ola
authors: O
authors: Ekholm
authors: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors: Finn
authors: F
authors: Diderichsen
mesh_terms: D000328:Adult; D000329:Advertising / Q000191:economics / Q000331:legislation & jurisprudence; D000428:Alcohol Drinking / Q000191:economics / Q000453:epidemiology / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D000434:Alcoholic Beverages / Q000191:economics / Q000600:supply & distribution; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D003718:Denmark / Q000453:epidemiology; D006801:Humans; D055815:Young Adult