Guidelines and reality in studies on the economic costs of alcohol use: a systematic review

Aim: To identify guidelines for estimating alcohol-attributable cost of illness (COI) and actual COI studies, and to assess to what extent core recommendations have been implemented. Design: The systematic review was conducted in February 2019 according to the PRISMA statement. Relevant COI guidelines and actual alcohol COI studies published since 2009 (when the last systematic review was published) were identified by searching databases MEDLINE and EMBASE, as well as literature known by the authors. Measures: Standards and recommendations of published COI guidelines, and actual COI studies estimating the total costs of alcohol. Findings: Fourteen guidelines and eighteen COI studies were identified, and relevant indicators were extracted. Large discrepancies between recommended and implemented methods were determined. Contrary to most current guidelines, which were barely acknowledged at all, (a) predefined direct and indirect cost groups were only partially included, (b) estimates were compared with GDP in only about half of the studies, and (c) avoidable costs - a complementary concept to the more common scenario of complete alcohol abstinence - were never estimated. Conclusions: Adherence to guidelines in published COI studies is low. We propose content-related and software-based solutions to adopting a common standard, which could reduce heterogeneity and enhance comparability in alcohol COI studies.