Quality of life of alcohol-related diseases and road accidents in Switzerland:

An economic assessment

France PriezThe University of North Carolina at Chapel Hill

NeuchâtelOctober 24th 2003

Social cost of substance abuse

Economic costs• Direct costs• Indirect costs

Quality of life

Burden for the society resulting from substance abuse and expressed in monetary units

Quality of life and alcohol abuse

Impact on health

e.g.

Road accidents

Diseases

Impact on behavior

e.g.

Drunkeness

Addiction

Impact of accidents and diseases on quality of life

• Physical consequences• Psychological impact• Changes in life style• Loss of life (if death)

Selection of diseases

Aetiological fraction Swiss incidence (1996) Diseases ICD-9

Male Female Male Female

Mainly attributable to alcohol abuse

Liver cirrhosis 571 0.90 0.90 929 428

Chronic pancreatic 577.1 0.84 0.84 211 86

Partly attributable to alcohol abuse

ENT cancer 140-150 0.21 0.08 1120 280

Hypertension 401-405 0.11 0.06 5200 6320

Sources: Gutjahr and Gmel (2001), OFS (1998), ISPA (1997), English et al. (1995)

How to measure quality of life

• SurveyAsk participants to tell what is their quality of life with specific accidents or diseases

• Monetary measure = human costsWillingness to pay to avoid accident or disease

• Scale = utility indexFull health = 1, Death = 0, Specific condition = ?

Methods

• Welfare Economics

• Expressed preferences

1. Contingent valuation

2. Standard gamble

Contingent Valuation

• Only for ENT cancer and hypertension (+ road accidents from former study)

• Describe health condition and main risk factors

• Present the average risk of suffering from such condition by gender

• Contingent market:

How much are you willing to pay to reduce your risk of suffering from such disease or having such accident

Standard Gamble

• For ENT cancer, hypertension, liver cirrhosis and chronic pancreatic

• Quality of life measured by a utility index between 1 (full health) and 0 (death)

Death

Full health

No treatment = Health condition

Treatment

p

1- p

Decision

Methodological decisions

• Selection and description of diseases• Pre-tests, in-depth interviews• Target population: general population• Health as private good• Ex-ante estimation• Sensitivity analysis: risk variations of 95% & 50%• Face-to-face interview• Quotas sampling

Two-step estimation

• 1st step (ENT cancer and hypertension)

Contingent valuation and standard gamble Human costs = - f [ utility index ]

• 2nd step (liver cirrhosis and chronic pancreatic)

Standard gamble only Plug utility index in above function to get human costs

Quota sampling

• Reasons: face-to-face interviews & visual cards

• Representative sample of Swiss population 18+

• Four quotas:

– Gender

– Rural versus urban

– Age group

– Socio-economic category

Sample sizes

Contingent valuation

Standard gamble 1

Standard gamble 2

Diseases ENT cancer Hypertension

ENT cancer Hypertension

Liver cirrhosis Chronic pancreatic

Sample size 164 159 155

Invalid questionnaires 1 14 (ENT) 16 (HYP)

3 (CIR) 6 (PAN)

Valid questionnaires 163 145 (ENT) 143 (HYP)

152 (CIR) 149 (PAN)

Missing income 5 15 7

Mean utility index of alcohol-related diseases

0.440.28 0.27

-0.040

1

-0.2

0

0.2

0.4

0.6

0.8

1

1'809'000

524'000 536'000

123'0000

1'155'000

0200'000400'000600'000800'000

1'000'0001'200'0001'400'0001'600'0001'800'0002'000'000

Mean human costs of alcohol-related diseases

Total human costs of alcohol-related diseases and road accidents in Switzerland in 1998

Human costs per case

Alcohol-related new cases

Total human costs (CHF million)

ENT cancer 1,809,000 258 466.7

Hypertension 123,000 951 116.9

Liver cirrhosis 524,000 1,221 639.5

Chronic pancreatic 536,000 249 133.4

Road accidents 3,663 1,182.6

Total 2,539.1

Economic costs 2,191.7

The End

Sample characteristics

Contingent valuation

Standard gamble 1

Standard gamble 2

Swiss population

(%) Sample (%)

Gender Male 48.2 48.8 49.4 46.1 Female 51.8 51.2 50.6 53.9

Area Urban 67.5 64.5 67.6 63.8 Rural 32.5 35.5 32.4 36.2

Age group 18-29 19.1 19.8 20.9 21.0 30-44 30.8 30.2 27.7 30.3 45-64 31.0 32.1 34.5 30.9 65+ 19.1 17.9 16.9 17.8

Occupation Mangers, highly skilled 11.0 11.1 12.8 11.2 Tradesmen, layers,… 29.0 30.2 29.0 29.6 Office & skilled 37.0 37.7 37.8 36.8 Unskilled 23.0 21.0 20.4 22.4

Contingent Valuation (2)

• Advantages– Theoretical foundations – Flexible– Price of non-market goods

• Disadvantages– ‘Fictive’ market– Potential biases– Potentially all costs faced by individuals

Standard Gamble (2)

• Advantages– Theoretical foundations – Measures quality of life only– No direct link with income

• Disadvantages– ‘Fictive’ market– Potential biases– No direct monetary value

Utility index and human costs of alcohol-related diseases

Utility index Human costs

Perfect health 1 0

Sudden death 0 1,155,000

ENT cancer -0.04 1,809,000

Hypertension 0.44 123,000

Liver cirrhosis 0.28 524,000

Chronic pancreatic 0.27 536,000

Alcohol-related road accidents in Switzerland in 1998

Number of cases

Death 139

Heavy disability 111

Partial disability 60

Temporary limitations 1’117

No limitation 2’236

Sources : Frei (2001), SSAA (2001), OFS (1999), Schwab Christe et al. (1995),