These notes detail further (it is contended) invalid or unnecessary uses of total cost studies.
Comparing alcohol-related costs to those related to other illnesses such as mental illness falls foul of conflicting assumptions, such as that distress cause by public drunkenness is to be costed, but not that caused by visible signs of psychiatric disturbance. In principle, it may be possible to reach a consensus on what items should be included in the comparison, but still it is hard to believe that the result would affect resource allocation.
Comparisons between the costs associated with drinking in different countries are invalid because many costs "reflect general societal decisions about investment in health, social welfare, and other systems of response to health and social problems". The same applies to the components of the grand total. The futility of such comparisons is revealed by the World Health Organization's comparison of 14 high-income countries. The share accounted for by productivity losses varied from 72.3% in the United States to 36.5% in Australia, and averages 71.9%. The overwhelming yet varying weight of this largely illusory cost (see main text) irretrievably distorts the comparisons. Other cost comparisons seem no more informative. For example, the share accounted for by healthcare costs ranges tenfold from 2.8% in New Zealand to 28.3% in Denmark, not a credible reflection of the true variance in the burden.
It has been argued that cost data helps target policy at the most costly forms of drinking but there seems no reason why more direct data such as such as government expenditure, mortality figures, crime statistics and drinking surveys could not do so more reliably.
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