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3 NHS Costs
3.1 Much of the data required to accurately estimate the cost to the health services in NHS Scotland which are attributable to alcohol use and/or misuse are not routinely collected. The approach adopted follows the methodology adopted in both the 2001 and 2004 report. NHS unit costs are sourced from the Scottish Health Service Costs 3 .
3.2 GP consultations: Data on consultation directly attributable to alcohol was obtained from Practice Team Information ISD Scotland (130,250 in 04/05). This cost approximately £4m. An additional number of indirect consultations with all community staff were calculated using estimates of "alcohol attributable fractions" i.e. proportion of mortality and morbidity from certain conditions which have an alcohol related risk. The methodology is outlined in the Cabinet Office Strategy Unit paper 4. Applying this methodology to all contacts using the alcohol attributable fractions for identifiable disease groups suggests an additional cost of between £3.5 and £12.5m. A mid point estimate of £8m is used.
3.3 GP-prescribed drugs: Disulfiram and Acamprostate are drugs specifically prescribed for alcohol dependency. Gross ingredient costs for these drugs were obtained from ISD. For 2006/07 the costs were disulfiram, £403,547 and acamprosate, £373,665. There are other drugs prescribed for alcohol withdrawal symptoms, in particular some of the benzodiazepines ( e.g. diazepam, chlordiazepoxide). The estimate of £0.77m is therefore likely to be an underestimate of the cost of GP prescribed drugs.
3.4 Laboratory testing in primary care: A similar assumption to that in the previous studies was used. It was assumed that for each consultation directly attributed to alcohol misuse there would be a biochemistry test (liver function tests) and a haematology test (mean corpuscular volume) requested. This leads to a figure of 260,500 tests at a cost of £840,000.
3.5 Hospitalisation days: the number of hospitalisation days directly attributable to alcohol - both acute and psychiatric - was obtained from alcohol related ICD codes ( ISD Scotland). In 2005/06 there were 140,796 acute bed days directly attributable to alcohol and 362,760 psychiatric. The average cost of a bed day was calculated from the Scottish Health Service Costs data: £374 for an acute bed and £259 for psychiatric.
3.6 The additional hospitalisation days indirectly attributed to alcohol were calculated using methodology outlined in the Cabinet Office Strategy Unit paper 5. This estimates the "alcohol attributable fractions" i.e. proportion of mortality and morbidity from certain conditions which have an alcohol related risk i. They produced low and high estimates based on work from WHO6, Britton& McPherson & Correo. This results in an additional number of acute hospitalisation days of around 234,000. The estimate for the total cost of acute hospitalisation days was £140.2m. Using slightly different assumptions raises the number of indirect admissions and suggests that the total cost of admissions could be over £150m.
3.7 The 2001 study estimated that an additional 1% of psychiatric admissions were indirectly attributable to alcohol. This assumption is replicated here adding nearly 4,000 bed days. The estimate for the total cost of psychiatric hospitalisation days was £94.8m.
3.8 A&E attendances: the number of attendances at A&E units in Scotland in 2006/07 (1,574,990) and the average cost of an attendance (£82) were obtained from the Scottish Health Service Costs Book. A QIS report (2006) 7 estimated that 11% of A&E attendances were alcohol related. This is at the lower end of estimates from various studies which have found rates of alcohol related attendance at A&E of between 4% and 46%. The Cabinet Office Strategy Unit suggested, from unpublished research commissioned by them, that up to 35% of all accident and emergency attendance and ambulance costs are alcohol related 8. The figure of 11% seems likely to be an underestimate. If the proportion is nearer 46% the cost would be around £59m. A figure of 25%, at a cost of £32.3m, is used in these estimates, which is both more consistent with the Strategy Unit work and nearer the mid point of other studies.
3.9 Out patient visits: there were 302,087 out patient general psychiatry visits in 2006/07. The cost of each psychiatric visit is £82. Using similar methodology to the 2001 report, it was calculated that 15% of psychiatric admissions are linked to alcohol: also that @ 5% of GP visits are due to an alcohol related psychiatric consultation. The mid point of this was used to estimate the number of psychiatric OP visits that were attributable to alcohol.
3.10 There were 6,131,162 out patient attendances (all types, excluding psychiatry, obstetrics, & learning disability). The cost of each general visit is £100. For inpatient episodes, between 5 and 8% are alcohol related (both direct and indirect). For GP visits alcohol related contacts represent in excess of 12% of contacts for the practice team. The number of OP visits associated with alcohol related disease (both direct and indirect) is estimated at 10%. This is in line with the WHO Global Burden of Disease which estimates that alcohol causes nearly 10% of all ill health and premature death in Europe. The total costs of outpatient visits was estimated at £63.5m.
3.11 Day hospital visits: there is data available for the number of visits and associated cost for both general psychiatric attendances and geriatric psychiatric attendance. Again the assumption the 10% of these may be alcohol related is used at a cost of £3.7m.
3.12 Community psychiatric team visits: again assumes that 10% of visits are attributable to alcohol related illness at a cost of £12.6m.
3.13 Ambulance journeys: activity and cost data were obtained from Scottish Health Service Costs. Assuming that alcohol related costs were most likely to be associated with "road ambulances": there were 569,372 road ambulance incidents at a cost of £221.51 per incident. The original study, and the update in 2004, used an assumption of 12% of road ambulance incidents attributed to alcohol 9. In light of the Strategy Unit assumption of 35%, a figure of 25% is used here with a cost estimate of £31.5m. This may still be an underestimate.
3.14 There are expenditure items directly attributable to alcohol use, rather than costs associated with resource use. These are included as costs to NHS Scotland for consistency with the previous estimates in 2001 and 2004. They include specific treatment and health promotion activities which are directly targeted at alcohol misuse. Treatment: there is specific budget attributed to alcohol treatment, including Drug and Alcohol teams. In 2006/07 this amounts to £11 million. Health promotion/prevention: there is money allocated for communications for ADAT teams and also to voluntary organisations; Alcohol Focus Scotland and Scottish Health Action on Alcohol Problems of around £600,000.
3.15 Joint drugs/alcohol funding: there have been many changes in policy/treatment approaches and in resources directed to substance misuse since the original research in 2001. There are many approaches which draw together expertise across both alcohol and drug misuse and funding is allocated in this manner. Where is has been possible to identify such funding it has been assumed that 50% is attributable to alcohol (£1.25m). This may underestimate in some cases and overestimate in others.
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