Are the “Best Buys” for Alcohol Control Still Valid? An Update on the Comparative Cost-Effectiveness of Alcohol Control Strategies at the Global Level
Abstract
OBJECTIVE: Evidence on the comparative cost-effectiveness of alcohol control strategies is a relevant input into public policy and resource allocation. At the global level, this evidence has been used to identify so-called best buys for noncommunicable disease prevention and control. This article uses global evidence on alcohol use exposures and risk relations, as well as on intervention costs and impacts, to re-examine the comparative cost-effectiveness of a range of alcohol control strategies. METHOD: A "generalized" approach to cost-effectiveness analysis was adopted. A new modeling tool (OneHealth) was used to estimate the population-level effects of interventions. Interventions that reduce the harmful use of alcohol included brief psychosocial interventions, excise taxes, and the enactment as well as enforcement of restrictions on alcohol marketing, availability, and drink-driving laws. Costs were estimated in international dollars for the year 2010 and effects expressed in healthy life years gained. Analysis was carried out for 16 countries spanning low-, middle-, and high-income settings. RESULTS: Increasing excise taxes has a low cost (<I$0.10 per capita) and a highly favorable ratio of costs to effects (<I$100 per healthy life year gained in both low- and high-income settings). Availability and marketing restrictions are also highly cost effective (<I$100 in low-income settings and <I$500 in high-income settings). Enforcement of drink-driving laws and blood alcohol concentration limits via sobriety checkpoints had cost-effectiveness ratios in the range of I$1,500-3,000. Brief psychosocial treatments were <I$150 and
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Legislative measures that reduce harmful behaviours such as excess alcohol consumption have been modelled as cost-effective in all WHO regions.
“Legislative measures that reduce harmful behaviours such as excess alcohol consumption have been modelled as cost-effective in all WHO regions. 442”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [442]
A broad array of patient-level alcohol harm reduction interventions, including brief interventions, psychosocial interventions, and pharmacological treatments, have been found to be effective in high-resource settings.
“A broad array of patient-level alcohol harm reduction interventions, such as brief interventions (for this paper, defined as any intervention ranging from advice to counseling, lasting less than 1 hour per session [7] up to 4 sessions [8], psychosocial interventions, and pharmacological treatments) have been found to be effective in high-resource settings [9,10].”
From Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary (2022) · cites this paper as [10]
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Self-citationAlcohol policies in India: A scoping review
Schess, J., Bennett-Li, L., Velleman, R. D. B., Bhatia, U., Catalano, A., Jambhale, A., & Nadkarni, A. (2023) · PLoS ONE · doi:10.1371/journal.pone.0294392 · Cited by 26 · see citing works
“Such approaches include restrictions on availability and marketing of alcohol, higher taxes on alcohol, enforcement of drink-driving laws, and brief psychosocial treatments for AUDs [11].”
BackgroundCorreia, D. M., Kokole, D., Rehm, J. T., Tran, A., Ferreira‐Borges, C., Galea, G., Likki, T., Olsen, A., & Neufeld, M. (2024) · The Lancet Public Health · doi:10.1016/s2468-2667(24)00102-6 · Cited by 24 · see citing works
Self-citationManthey, J., Jasilionis, D., Jiang, H., Meščeriakova-Veliulienė, O., Petkevičienė, J., Radišauskas, R., Štelemėkas, M., & Rehm, J. T. (2023) · BMC Medicine · doi:10.1186/s12916-022-02721-6 · Cited by 24 · see citing works
Self-citationTran, A., Jiang, H., Kim, K. V., Room, R., Štelemėkas, M., Lange, S., Rovira, P., & Rehm, J. T. (2022) · Alcohol and Alcoholism · doi:10.1093/alcalc/agac003 · Cited by 23 · see citing works
Self-citationChrystoja, B. R., Monteiro, M. G., Owe, G., Gawryszewski, V. P., Rehm, J. T., & Shield, K. D. (2021) · Addiction · doi:10.1111/add.15475 · Cited by 22 · see citing works
Self-citationDumbili, E. W., Uwa-Robinson, K., & Odeigah, O. W. (2022) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2022.103646 · Cited by 22 · see citing works
Kilian, C., Rovira, P., Neufeld, M., Ferreira‐Borges, C., Rumgay, H., Soerjomataram, I., & Rehm, J. T. (2021) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2021.100225 · Cited by 22 · see citing works
“Cost-effective alcohol control policies, such as the WHO “Best Buys” [15], exist which can reduce the alcoholattributable burden [16].”
BackgroundSelf-citationSo, V., Millard, A. D., Katikireddi, S. V., Forsyth, R., Allstaff, S., Deluca, P., Drummond, C., Ford, A., Eadie, D. R., Fitzgerald, N., et al. (2021) · Public Health Research · doi:10.3310/phr09110 · Cited by 19 · see citing works
Probst, C., Könen, M., Rehm, J. T., & Sudharsanan, N. (2022) · Health Affairs · doi:10.1377/hlthaff.2021.01905 · Cited by 21 · see citing works
Self-citationReduction in global alcohol-attributable harm unlikely after setback at WHO Executive Board
Casswell, S., & Rehm, J. T. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30476-1 · Cited by 21 · see citing works
Self-citationAlkohol: Kein gewöhnliches Konsumgut
Babor, T. F., Casswell, S., Graham, K., Huckle, T., Livingston, M., Rehm, J. T., Room, R., Rossow, I. M., & Sornpaisarn, B. (2023) · SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice · doi:10.1024/0939-5911/a000822 · Cited by 21 · see citing works
Self-citationChanges in alcohol consumption in Spain between 1990 and 2019
Llamosas‐Falcón, L., Manthey, J., & Rehm, J. T. (2020) · Adicciones · doi:10.20882/adicciones.1400 · Cited by 20 · see citing works
“…driving under the influence, and offering interventions in primary care (the first three are recommended as “best buys” as they are highly cost-effective and easy to implement (Chisholm et al., 2018); all five measures are subsumed in the SAFER initiative of WHO (World Health Organization, 2018b)).”
BackgroundSelf-citationVallance, K., Stockwell, T. R., Wettlaufer, A., Chow, C. M., Giesbrecht, N., April, N., Asbridge, M., Callaghan, R. C., Cukier, S. N., Hynes, G., et al. (2021) · Drug and Alcohol Review · doi:10.1111/dar.13251 · Cited by 19 · see citing works
Casswell, S., Huckle, T., Parker, K., Romeo, J. S., Graydon‐Guy, T., Leung, J. Y. Y., Byron, K., Callinan, S., Chaiyasong, S., Gordon, R., et al. (2022) · PLOS Global Public Health · doi:10.1371/journal.pgph.0000109 · Cited by 19 · see citing works
Binge Drinking and Alcohol Problems Among Moderate Average-Level Drinkers
Holahan, C. J., HOLAHAN, C., & Moos, R. H. (2022) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2022.03.021 · Cited by 20 · see citing works
“Alcohol control policies focused on the price and availability of alcohol are especially effective in reducing binge drinking at a population level.(35,36) A significant contribution to such efforts can also come from primary care providers, who interact with a broad spectrum of adults who consume alcohol.”
BackgroundRehm, J. T., O'Donnell, A. J., Kaner, E., Jané‐Llopis, E., Manthey, J., & Anderson, P. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-054161 · Cited by 19 · see citing works
Self-citationKilian, C., Manthey, J., Moskalewicz, J., Sierosławski, J., & Rehm, J. T. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16224461 · Cited by 19 · see citing works
“In 2016, there was a relatively high overall implementation of alcohol policies, however, some of the most effective and cost-effective policies such as pricing or marketing regulations [4] lagged behind [1,5].”
BackgroundSelf-citationJain, V., Crosby, L., Baker, P., & Chalkidou, K. (2020) · Health Policy · doi:10.1016/j.healthpol.2020.05.022 · Cited by 19 · see citing works
Rehm, J. T., Assanangkornchai, S., Hendershot, C. S., Franklin, A., Neufeld, M., Hassan, A. S., & Shield, K. D. (2025) · The Lancet · doi:10.1016/s0140-6736(25)01496-5 · Cited by 23 · see citing works
Self-citationHeterogeneity in trends of alcohol use around the world: Do policies make a difference?
Rehm, J. T., Babor, T. F., Casswell, S., & Room, R. (2021) · Drug and Alcohol Review · doi:10.1111/dar.13248 · Cited by 18 · see citing works
Self-citationMYERS, B. J., Carney, T., Rooney, J. A., Malatesta, S., White, L. F., Parry, C. D. H., Bouton, T. C., Ragan, E. J., Horsburgh, C. R., Warren, R. M., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105449 · Cited by 18 · see citing works
“Restricting alcohol and tobacco availability is considered an effective policy measure for reducing alcohol- and tobacco-attributable harms, [25] but has been contested by the alcohol and tobacco industries [4].”
BackgroundAffordability of Alcoholic Beverages in the European Union
Kilian, C., Manthey, J., Neufeld, M., & Rehm, J. T. (2022) · European Addiction Research · doi:10.1159/000527096 · Cited by 18 · see citing works
Self-citationMaking the WHO European Region SAFER: developments in alcohol control policies, 2010–2019
WHO Regional Office for Europe (2021) · World Health Organization, Regional Office for Europe eBooks · doi:10.37426/9789289055048 · Cited by 18 · see citing works
Secombe, P. J., Campbell, L. T., Brown, A. D. H., Bailey, M., & Pilcher, D. V. (2021) · Addiction · doi:10.1111/add.15432 · Cited by 17 · see citing works
Swahn, M. H., Martínez, P., Balenger, A., Luningham, J. M., Seth, G., Awan, S., & Aneja, R. (2024) · BMC Public Health · doi:10.1186/s12889-024-18565-z · Cited by 17 · see citing works
“Additionally, recent work suggests that awareness of the carcinogenic nature of alcohol is associated with support for alcohol control policies [38–41], which are known to reduce per capita alcohol consumption and population-level alcohol related harms [42].”
BackgroundValidation of a screening test for alcohol use, the Russian Federation
Neufeld, M., Rehm, J. T., Bunova, A., Gil, A. U., Gornyi, B., Rovira, P., Manthey, J., Yurasova, E., Dolgova, S. V., Idrisov, B. T., et al. (2021) · Bulletin of the World Health Organization · doi:10.2471/blt.20.273227 · Cited by 17 · see citing works
Self-citationThe Comprehensive Alcohol Advertising Ban in Lithuania: A Case Study of Social Media
Galkus, L., Lange, S., Liutkutė, V., Miščikienė, L., Petkevičienė, J., Rehm, J. T., Štelemėkas, M., Tran, A., & Vaitkevičiūtė, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912398 · Cited by 17 · see citing works
“In response, the Lithuanian government implemented all of the World Health Organization’s (WHO) “best buys” within a short time span—a set of alcohol control policies that are the most effective and cost-effective at reducing alcohol-related harm—which include excise taxation, reduced availability and marketing restri…”
Self-citationProbst, C., Manthey, J., Neufeld, M., Rehm, J. T., Breda, J., Ivo Rakovac, A., & Ferreira‐Borges, C. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17103423 · Cited by 17 · see citing works
“The latter three interventions are considered to be the most cost-effective and feasible for implementation and are therefore classified as the three “best buys” for preventing and reducing NCD burden stemming from alcohol [22,25].”
BackgroundSelf-citationThe early impact of Scotland's minimum unit pricing policy on alcohol prices and sales
Xhurxhi, I. P. (2020) · Health Economics · doi:10.1002/hec.4156 · Cited by 16 · see citing works
Interventions to prevent alcohol use: systematic review of economic evaluations
Le, L. K., Faller, J., Chatterton, M. L., Perez, J. K., Chiotelis, O., Tran, H. N. Q., Sultana, M., Hall, N. Y., Lee, Y. Y., Chapman, C., et al. (2023) · BJPsych Open · doi:10.1192/bjo.2023.81 · Cited by 16 · see citing works
Rehm, J. T., Štelemėkas, M., Kim, K. V., Zafar, A., & Lange, S. (2021) · Journal of Health Inequalities · doi:10.5114/jhi.2021.113167 · Cited by 16 · see citing works
“taxation increases, availability restrictions and bans on advertisement and marketing [16, 17].”
Self-citationRovira, P., Kilian, C., Neufeld, M., Rumgay, H., Soerjomataram, I., Ferreira‐Borges, C., Shield, K. D., Sornpaisarn, B., & Rehm, J. T. (2020) · European Addiction Research · doi:10.1159/000511899 · Cited by 15 · see citing works
Self-citation
- Authors
- Chisholm, D., Moro, D., Bertram, M., Pretorius, C., Gmel, G., Shield, K., & Rehm, J.
- Affiliations
- World Health Organization (CH)
- University of Cagliari (IT)
- Avenir Health (US)
- Centre for Addiction and Mental Health (CA)
- Venue
- Journal of Studies on Alcohol and Drugs
- Publisher
- Alcohol Research Documentation, Inc.
- Published
- 2018-07
- Volume
- 79
- Issue
- 4
- Pages
- 514-522
- ISSN
- 1937-1888 (ISSN-L)
- 1938-4114
- OpenAlex
- W2886141074
- Cited by
- 253
- References
- 0
- Citations by year
- 2026: 12 · 2025: 25 · 2024: 32 · 2023: 36 · 2022: 39 · 2021: 56 · 2020: 32 · 2019: 17 · 2018: 4
- FWCI
- 21.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Studies on Alcohol and Drugs (publishedVersion)
- PubMed (publishedVersion)
- Funders
- World Health Organization
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- cost-effectiveness, Best Buy, excise tax, alcohol marketing restrictions, alcohol availability restrictions, sobriety checkpoints, brief psychosocial intervention, hazardous drinking, healthy life years, non-communicable disease prevention
- MeSH terms
- Blood Alcohol Content, Alcohol Drinking, Automobile Driving, Cost-Benefit Analysis, Female, Humans, Male, Public Policy, Taxes, Global Health, Marketing
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