บทคัดย่อ
การศึกษาในครั้งนี้มีวัตถุประสงค์เพื่อประเมินต้นทุนทางเศรษฐกิจจากการบริโภคเครื่องดื่มแอลกอฮอล์ในประเทศไทยในปี พ.ศ. 2549 โดยใช้กรอบแนวคิดของการศึกษาต้นทุนของความเจ็บป่วย (cost of illness study) ทำการวิเคราะห์ต้นทุนโดยใช้วิธีความชุก (prevalence based) ซึ่งเป็นการวิเคราะห์ต้นทุนที่เกิดขึ้นจากการบริโภคเครื่องดื่มแอลกอฮอล์ทั้งในอดีตและปัจจุบัน ซึ่งส่งผลให้เกิดต้นทุนในปีที่ทำการวิเคราะห์ ทั้งนี้ทำการประเมินต้นทุนที่เกิดขึ้นในลักษณะของต้นทุนความสูญเสีย (gross cost) ซึ่งประเมินเฉพาะต้นทุนที่เกิดขึ้นจากการบริโภคเครื่องดื่มแอลกอฮอล์เท่านั้น โดยไม่ได้ประเมินประโยชน์ที่อาจเกิดขึ้นจากการการบริโภคเครื่องดื่มแอลกอฮอล์ สำหรับในส่วนของการวิเคราะห์ต้นทุนทางอ้อมทำโดยใช้วิธีทุนมนุษย์ (human capital approach) ต้นทุนที่ทำการประเมินในครั้งนี้ครอบคลุมทั้งต้นทุนทางตรง (direct cost) และต้นทุนทางอ้อม (indirect cost) โดยต้นทุนทางตรงที่ทำการประเมิน ได้แก่ ต้นทุนค่ารักษาพยาบาล (health care cost) ต้นทุนเกี่ยวกับการบังคับใช้กฎหมายและการฟ้องร้องคดีความ (law enforcement and criminal justice cost) และต้นทุนทรัพย์สินที่เสียหายจากอุบัติเหตุจราจรทางบก (cost of property loss due to traffic accident) และในส่วนของต้นทุนทางอ้อมที่ทำการประเมิน ได้แก่ ต้นทุนจากการเสียชีวิตก่อนถึงวัยอันควร (cost of premature mortality) และต้นทุนจากการสูญเสียประสิทธิภาพในการทำงาน (cost of reduced productivity) ทั้งจากการขาดงาน (absenteeism) และการขาดประสิทธิภาพขณะทำงาน (presenteeism)
บทคัดย่อ
This study aims to provide estimate of the economic costs of alcohol consumption in Thailand
2006. It is prevalence-based (i.e. estimate the economic costs of alcohol associated with the past and
current use in the given year, 2006), using the cost-of-illness methodology. Human capital approach
is employed in estimating cost of productivity loss due to premature mortality. The estimated cost in
this study represents the gross cost, in which only the costs associated with negative effects of alcohol
consumption has been estimated.
Both direct cost and indirect cost are included in the estimation. Direct cost includes health
care cost, law enforcement and criminal justice cost, and cost of property loss due to traffic accident
while indirect consists of cost of productivity loss due to premature mortality and cost of reduced
productivity from absenteeism and presenteeism.
According to this study, alcohol consumption costs 156,105 Million Baht or 1.99% of Gross
Domestic Product (GDP), resulting in approximately 2,391 Baht per capita. Indirect cost outweighs the
direct cost, representing 95.8 % of the total cost. The largest cost attributable to alcohol consumption
is cost of productivity loss due to premature mortality (104,128 Million Baht, accounted for 65.7% of
total cost), followed by cost of productivity loss due to reduced productivity (45,464.6 Million Baht,
accounted for 30.1% of total cost), health care cost (5,491.1 Million Baht, accounted for 3.5% of total
cost), cost of property damage due to road traffic accident (779 Million Baht, accounted for 0.5% of
total cost), and cost of laws enforcement and criminal justice (242 Million Baht, accounted for 0.2%
of total cost), which consisted of court cost (156 Million Baht) and police cost (86 Million Baht.),
respectively.
In Thailand 2006, it was found that there were 3,029,427 patients attributable to alcohol
consumption. Of these amounts, 2,675,513 were male while 353,914 were female. When looking at
the number of hospitalization due to alcohol consumption, it was found that there were 218,799
admissions attributable to alcohol. Of this amount, 168,549 hospitalizations were from male while
50,250 were from female. The 5 leading causes of health care cost are road traffic accident (approx.
1,232 Million Baht), HIV/AIDS (approx. 1,088 Million Baht), alcohol abuse (approx. 574 Million Baht),
epilepsy (approx. 537 Million Baht), and alcohol dependence (approx. 430 Million Baht), respectively.
Regarding the cost of productivity loss, it was found that there were 39,459 deaths attributable
to alcohol consumption in Thailand 2006. Of these amount, 33,493 were male, while 5,966 were
female, resulting in the total number of years of life lost due to premature mortality of 1,390,899 years
(male 1,164,551 years, female 226,348 years) Among male, the 3 leading causes of productivity loss
due to premature death were HIV/AIDS (approx. 36,277 millions Baht, 10,204 deaths), traffic
accidents (approx. 26,989 millions Baht, 8,460 deaths), and cirrhosis (approx. 13,044 5,147 deaths), respectively. On the other hand, the 3 leading causes of productivity loss due to
premature death among female are HIV/AIDS (approx. 3,580 millions Baht, 1,877 deaths), traffic
accident (approx. 2,796 millions Baht, 1,848 deaths), and liver cancer (approx 706 millions Baht, 868
death), respectively. In addition, it was found that the cost of productivity loss was highest among
those who were 30-44 years old (13,622 deaths resulting in 49,827 millions Baht) followed by those
who were 15-29 years old (7,275 deaths resulting in 25,912 millions Baht), respectively.
Although this is the current best estimate for Thailand it should be interpret along with the
results of the sensitivity analyses. According to the sensitivity analyses, economic cost of alcohol
consumption ranges between 126,311 to 214,053 millions Baht depending on methodology and value
of parameters employed in the estimation. The result from sensitivity analyses found that the choice of
discount rates makes a considerable difference to the total estimated of economic cost of alcohol,
while the method used in estimating cost of reduced productivity due to absenteeism and presenteeism,
and the inclusion of cost of premature mortality among non-working population have medium effect
to the total estimated cost. On the other hand, proportion of alcohol attributable to road traffic accident
and inclusion of health benefits form alcohol consumption have only minor effect on the total
estimated cost.
This study revealed that direct cost associated with alcohol consumption in term of health
care cost, cost of laws enforcement, and cost of property damage was estimated at 6, 512 Million Baht
or accounted for about 0.1% of Gross Domestic Product (GDP). However, alcohol consumption also
led to the indirect cost in terms of productivity loss due to premature mortality and reduced productivity
which cost approximately 150,000 Million Baht. According to the statistics from Excise Department,
the excise tax generated from alcohol beverage in 2006 was 72,871 Millions Baht or accounted
for 0.93% of GDP. Based on these findings, the Thai government needs to pay more attention to the
implementation of more effective alcohol policies aimed at reducing alcohol consumption and harms
associated with alcohol, including tax policies or other related policies while balancing between
revenues and costs generated from alcohol.
millions Baht,
