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Impact of minimum unit pricing on alcohol-related hospital outcomes: systematic review
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  • Published on: 27 February 2023
    Author's response: Impact of Minimum Unit Pricing on Hospital Discharges for Alcohol-related Liver Disease
    • Tobias Maharaj, Clinical Research Fellow Royal College of Surgeons in Ireland, Dublin, Ireland; Hepatology Unit, Beaumont Hospital, Dublin, Ireland
    • Other Contributors:
      • Colin Angus, Senior Research Fellow
      • Niamh Fitzgerald, Professor of Alcohol Policy
      • Kathryn Allen, Medical doctor
      • Stephen Stewart, Consultant Hepatologist
      • Siobhan MacHale, Consultant Liaison Psychiatrist
      • John D Ryan, Consultant Hepatologist

    Dear Editor,

    To Prof Forrest and the authors of the Chaudhary et al paper(1): Thank you for your response to our review(2) in which you highlight that there was a significant reduction in alcohol-related liver disease (ALD) discharges following the introduction of minimum unit pricing (MUP) at your unit. This is an important point to highlight as a misrepresentation of the Chaudhary et al study in our review.

    In our review, we reported the outcome measure of mean weekly ALD discharges before and after MUP for 'All hospital episodes' which did not reach pre-defined significance (6.2 versus 5.2; p = 0.123) in the Chaudhary et al study, however the outcomes for 'individual patients' and those 'actively drinking' did indeed reach pre-defined significance and should have been included in our review. These outcomes from the Chaudhary et al study would certainly be consistent with the overall conclusion of our review, adding further support to the impact of MUP reducing alcohol-related hospital burden as you have highlighted.

    We would also like to correct the reference to your study in the main text of our review which should read “Chaudhary et al” and not “Ferguson et al” (found under ‘Results’, subheading ‘Natural experiments’).

    References
    1. Chaudhary S, MacKey W, Duncan K, Forrest EH. Changes in Hospital Discharges with Alcohol-Related Liver Disease in a Gastroenterology and General Medical Unit Following the...

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    Conflict of Interest:
    None declared.
  • Published on: 10 February 2023
    Impact of Minimum Unit Pricing on Hospital Discharges for Alcohol-related Liver Disease
    • Ewan H Forrest, Consultant Hepatologist Glasgow Royal Infirmary and University of Glasgow

    Dear Editor,
    The recent systematic review by Maharaj et al on the impact of minimum unit pricing on alcohol-related hospital outcomes is a welcome addition to the literature on this subject1. The mirroring of real-world experience of minimum pricing of alcohol with modelling studies provides yet further support for this public health measure.
    As part of their review, the authors cite our study which assessed the impact of minimum pricing of alcohol specifically on alcohol-related liver disease hospital episodes2. In the review it is stated that our study showed ‘no change in ALD hospital discharge rate’ after the introduction of minimum pricing. This conclusion is reiterated in the discussion. However I fear this is a misrepresentation of our study. When we reviewed patients discharged from the specialist Gastroenterology wards at Glasgow Royal Infirmary before and after the introduction of minimum unit pricing, we did find that there was a significant reduction in alcohol-related liver disease discharges. What did not change was the proportion of those patients with specific complications of liver disease such as ascites, hepatic encephalopathy or alcoholic hepatitis. Neither was there any change in mortality. Whilst accepting the limitations of our study as raised in the discussion, these results indicate that minimum unit pricing did reduce the number of hospital episodes with alcohol-related liver disease. However for those fewer patients who did require ho...

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    Conflict of Interest:
    None declared.