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Evidence for the effectiveness of minimum pricing of alcohol: a systematic review and assessment using the Bradford Hill criteria for causality
  1. Sadie Boniface1,
  2. Jack W Scannell2,
  3. Sally Marlow1
  1. 1Department of Psychology and Neuroscience, National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
  2. 2School of Social and Political Science, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Sadie Boniface; sadie.boniface{at}


Objectives To assess the evidence for price-based alcohol policy interventions to determine whether minimum unit pricing (MUP) is likely to be effective.

Design Systematic review and assessment of studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, against the Bradford Hill criteria for causality. Three electronic databases were searched from inception to February 2017. Additional articles were found through hand searching and grey literature searches.

Criteria for selecting studies We included any study design that reported on the effect of price-based interventions on alcohol consumption or alcohol-related morbidity, mortality and wider harms. Studies reporting on the effects of taxation or affordability and studies that only investigated price elasticity of demand were beyond the scope of this review. Studies with any conflict of interest were excluded. All studies were appraised for methodological quality.

Results Of 517 studies assessed, 33 studies were included: 26 peer-reviewed research studies and seven from the grey literature. All nine of the Bradford Hill criteria were met, although different types of study satisfied different criteria. For example, modelling studies complied with the consistency and specificity criteria, time series analyses demonstrated the temporality and experiment criteria, and the analogy criterion was fulfilled by comparing the findings with the wider literature on taxation and affordability.

Conclusions Overall, the Bradford Hill criteria for causality were satisfied. There was very little evidence that minimum alcohol prices are not associated with consumption or subsequent harms. However the overall quality of the evidence was variable, a large proportion of the evidence base has been produced by a small number of research teams, and the quantitative uncertainty in many estimates or forecasts is often poorly communicated outside the academic literature. Nonetheless, price-based alcohol policy interventions such as MUP are likely to reduce alcohol consumption, alcohol-related morbidity and mortality.

  • alcohol
  • policy
  • minimum unit pricing
  • Bradford Hill

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors SM conceived the idea. SB conducted the initial search. SM and SM contributed to independently reviewing abstracts, hand-searching reference lists, completing data extraction and conducting quality appraisal. All authors contributed to the analysis and interpretation of the results and contributed to writing the manuscript. SB is guarantor.

  • Funding Open access for this article was funded by King's College London Open Scholarship Fund.

  • Competing interests SB and SM work at King's College London, which as an institution is listed as a member of the Alcohol Health Alliance. SM has received funding indirectly from UKCTAS, which as an institution is also listed as a member of the Alcohol Health Alliance. None of the authors have any relationship with the Alcohol Health Alliance.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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