Impact of reducing alcohol consumption through price‐based policies on cancer incidence in Germany 2020–50—a simulation study

Abstract

Background and Aims Alcohol is a major cancer risk factor and contributes considerably to the cancer burden in Germany. We aimed to provide projections of preventable cancer cases under different price-based alcohol policy scenarios.Design A macro-simulation approach was used to estimate numbers and proportions of cancer cases prevented under different price-based alcohol policy scenarios. Setting and participants Published price elasticities for main alcoholic beverages were applied to the mean daily intake of pure alcohol in the German population calculated from the German Health Interview and Examination Survey for Adults 2008-11 (DEGS1) to obtain hypothetical exposure distributions of alcohol consumption under different scenarios of changing price for alcoholic beverages. Measurements Age, sex and cancer site-specific potential impact fractions were calculated for different scenarios of changing the price of alcohol (single price increases, repeated price increases, volumetric price increase) for each year of a 30-year study period (2020-50).Findings Over a 30-year horizon, an estimated 4.7% (men = 10.1%, women = 1.4%) of alcohol-related cancer cases could be prevented in Germany, if alcohol intake above risk thresholds were reduced to levels below risk thresholds. Accordingly, the burden of new cancers would be reduced by approximately 244 000 cases (men = 200 000, women = 44 000). Of all price-based alcohol policy scenarios, a 100% price increase on alcoholic beverages was estimated to be most effective with approximately 213 000 (4.1%; men = 167 000; women = 47 000) preventable alcohol-related cancer cases, followed by 5-yearly 25% price increases (2.8%; men = 115 000, women = 29 000) and a volumetric price increase according to the beverage-specific alcohol content (1.9%; men = 72 000, women = 24 000). Conclusions Simulations suggest that a substantial number of alcohol-related cancer cases could be avoided in Germany by applying price-based policies to reduce consumption of alcoholic beverages.

Association Between Alcohol Consumption and Risk of Bladder Cancer: A Dose-Response Meta-Analysis of Prospective Cohort Studies

“…The bidirectional relationship between lifestyle factors and disease might be systemic and multifaceted, for which lifestyle interventions might have a positive impact on overall health in addition to optimizing the disease-specific outcomes (41,42). As a common additive to beverages, the relation of alcohol and bladder cancer risk was still contradictory though much cancer was linked with alcohol consumption (7,43). Past reviews of epidemiological data on alcohol consumption and bladder cancer risk concluded no association and attributed the moderate increase in risk observed in some investigations to residual confounding by smoking, or to an association between alcohol, coffee, and yet unidentified risk factors for bladder cancer (44,45).…”

Can alcohol consumption in Germany be reduced by alcohol screening, brief intervention and referral to treatment in primary health care? Results of a simulation study

“…While further efforts are needed to increase SBIRT delivery in German PHC settings in the long run, e.g., by financial reimbursement of alcohol management activities [ 53 ], alternatives may be required to reduce alcohol consumption and attributable burden in the short-term. In the light of very low alcohol taxation rates, including no taxes for wine [ 54 ], there is a large untapped potential in increasing retail prices for alcoholic beverages, which was demonstrated in two recent modeling studies [ 55 , 56 ]. Evidence from Lithuania and Great Britain, for example, demonstrates the impact that policies targeting alcohol prices can have in reducing consumption and harm [ 57 – 60 ].…”

Alcohol taxation, alcohol consumption and cancers in Lithuania: A case study

“…Our analyses arrive at similar conclusions as recent work in other countries. Gredner et al (2020) looked into the possibility of price-based policies on cancer incidence, and concluded that increases in the price of alcoholic beverages will result in substantial decreases in cancer incidence. Similarly, Rovira and colleagues modelled taxation increases in four countries in the WHO European Region, and found that taxation increases would result in decreases of cancer incidence and mortality, in line with the level of current taxation measured as a proportion of price ( Rovira et al, 2020 ).…”