Resumen

MEDINA-MORA, María Elena et al. Cost-effectiveness study of interventions to prevent alcohol abuse in Mexico. Salud Ment [online]. 2010, vol.33, n.5, pp.373-378. ISSN 0185-3325.

Introduction In Mexico, alcohol abuse involves overhead costs in terms of premature mortality caused by their related health problems. It is estimated that by itself it implies 9% of the total burden of disease in the country. Although effective interventions exist to treat this problem, national public policies are not integrated and in many occasions its real application is questioned. Cost-effectiveness studies are tools that permit to develop and to implement health public policies because they imply a rigorous economic evaluation and comparison of those in order to determine which obtains better balance between effectiveness and financial viability. Thus, the aim of the present study was to determine the cost-effectiveness of interventions to prevent and to control alcohol abuse in Mexico, based on the proposed methodology by the World Health Organization. It will permit to generate national public policies with local evidence and to carry out evaluations of their impact, as well as international comparisons. Method The World Health Organization methodology named WHO-CHOICE (CHOosing the Interventions that are Cost-Effective) was developed to evaluate and to select the most cost-effective interventions for the prevention or treatment of health problems. It is considered a generalized cost-effective analysis; therefore direct or tangible costs are particularly analyzed (vs. indirect or intangible costs). Procedure First, WHO-CHOICE analysis requires information from different sources about both the illness or problem and the preventive or therapeutic interventions to evaluate. Then, information is processed by special software. As annual standard discount of 3% is done to obtain and to compare the present supplies values; and age of individuals is praised, giving more weight to the young phases. Finally, the results are presented in terms of intervention cost-effectiveness to reduce the burden of disease, defined in terms of disability adjusted life years or DALYs. Interventions The following interventions were evaluated: 1. Current Setting: Taxes and random tests for the detection of alcoholic breath (breathalyzer); 2. Increment of 25% to taxes of products with harmful degree of alcohol; 3. Increment of 50% to taxes of products with harmful degree of alcohol; 4. Reduction of availability of products with harmful degree of alcohol; 5. Regulation of the associated publicity; 6. Brief preventive-persuasiveness intervention in the first level of attention; and 7. Random Tests for detection of alcoholic breath (breathalyzer). Results The independent measure with greater cost-effectiveness to avoid DALYs due to alcohol abuse was the increment of taxes, which is better when it reaches 50%. All increment of taxes avoids (with or without discount and adjustment by age) more than 1 50 000 DALYs per year. The increment of 50% surpasses even 300 000 DALYs per year (without adjustment neither discount). In contrast, none of the other interventions (with adjustment and discount) reaches 50 000 DALYs per year. Besides, the increments of taxes are always more economic than the interventions remainder. The extreme comparison of DALY avoided per year costs is among 50% taxes increment, which requires an investment of 567 Mexican pesos, and the brief intervention in the first level of attention, that implies an expense of 14,342 Mexican pesos. After taxes increment, effective independent interventions to reduce DALYs in Mexico include, in this order: reduction of the offering, integral prohibition of alcohol consumption publicity, brief intervention in the first level of attention, and the random test of alcoholic breath. Finally, the best integral strategy was a combination of the following measures: increment of taxes, greater proportion of people attended with brief interventions, control of publicity, and reduction of availability. Discussion In Mexico, as in many countries of the world, the increase of taxes was the most cost-effective intervention to reduce burden caused from abuse alcohol. This kind of interventions should consider the possible differential impacts according to the socioeconomical status of individuals or groups. Another related problem could be an increment of informal market. Therefore, it is necessary to complement the intervention with strategies directed at reducing the volume of alcoholic beverages that do not pay taxes. All other interventions (not taxes increment) were less cost-effective probably because they have considerably higher costs and smaller impact due their dispensation is eventual. Results of this exercise can have a positive impact among Mexican public policies on the field if the relevance of integral strategies is recognized, with political support, and having achieved a consensus of the population on the advantages of its orchestration.

Palabras llave : Alcohol; prevention; cost-effectiveness; public policy; Mexico.

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