Alcohol-Related Liver Disease in the US: Projections of Future Burden and Economic Evaluation of Pricing Policies

Abstract

Alcohol-related liver disease (ALD) is a set of conditions caused by repeated liver injury that results from chronic and excessive alcohol consumption. ALD is a significant cause of morbidity and mortality in the US; it is currently the cause of half of all cirrhosis-related deaths and is the leading indication for liver transplantation. ALD-related mortality rates are increasing in the US, especially among women, certain racial/ethnic minority groups, and young adults, which raises health equity concerns. The burden of ALD is expected to rise as alcohol use and misuse continue to increase in these populations. To advance our understanding of ALD and the potential impact of evidence-based policy interventions in the US, I conducted three studies. In the first study (Chapter 2), I developed a calibrated microsimulation model and projected the future burden of ALD across different subgroups. I estimated that ALD cases and deaths may increase in the US as rates of alcohol misuse rise. I found that average ALD incidence and mortality rates masked stark differences between sociodemographic groups. I also found that groups that have been disproportionately affected by ALD in the past are still likely to bear its health burden in the future. In the second study (Chapter 3), I compared the long-term costs, health benefits, and cost-effectiveness of two pricing policies, namely increases to alcohol excise taxes and minimum unit pricing (MUP). I found that alcohol tax increases and MUP are cost-saving or cost-effective interventions when compared to the status quo. Among all interventions, an MUP that increased the price of the cheapest alcohol by 100% had the highest probability of providing the most value for money, though results were sensitive to parameter uncertainty. In the third and final study (Chapter 4), I applied a distributional cost-effectiveness analysis framework to evaluate the cost-effectiveness and equity impacts of beer and liquor taxes. I leveraged previous estimates of the heterogeneous effects of pricing policies across racial/ethnic and gender groups. I found that a 30% liquor tax increase was the most economically efficient intervention compared to the status quo or to other liquor and beer taxes included in the analysis. However, the 30% liquor tax was associated with the highest health inequality, which is likely outweighed by the total health benefits produced. The studies in dissertation found that that the burden of ALD is expected to increase in the US, and that pricing policies are effective interventions to reverse this trend. However, pricing policies may have heterogeneous effects across subgroups that require further evaluation. This dissertation emphasizes the need to explore the distributional effects of interventions to ensure that they are effective, efficient, and equitable.PHDHealth Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/174231/1/antonlv_1.pd