Estimated cost per capita of alcohol-related hospital admissions (Broad) - WMCA

Crude rate of cost of admissions for alcohol-related conditions (Broad definition) per head of population. ## Rationale Alcohol misuse across the UK is a significant public health problem with major health, social, and economic consequences. This indicator aims to highlight the impact of alcohol-related conditions on inpatient hospital services in England. High costs of alcohol-related admissions are indicative of poor population health and high alcohol consumption. This indicator highlights the resource implications of alcohol-related conditions and supports the arguments for local health promotion initiatives. Publication of this indicator will allow national and local cost estimates to be updated and consistently monitored going forward. This measure accounts for just one aspect of the cost of alcohol to society, but there are others such as primary care, crime, ambulatory services, and specialist treatment services as well as broader costs such as unemployment and loss of productivity. The Government has said that everyone has a role to play in reducing the harmful use of alcohol. This indicator is one of the key contributions by the Government (and the Department of Health and Social Care) to promote measurable, evidence-based prevention activities at a local level, and supports the national ambitions to reduce harm set out in the Government's Alcohol Strategy. This ambition is part of the monitoring arrangements for the Responsibility Deal Alcohol Network. Alcohol-related admissions can be reduced through local interventions to reduce alcohol misuse and harm. References: (1) PHE (2020) The Burden of Disease in England compared with 22 peer countries [https://www.gov.uk/government/publications/global-burden-of-disease-for-england-international-comparisons/the-burden-of-disease-in-england-compared-with-22-peer-countries-executive-summary] ## Definition of numerator The total cost (£s) of alcohol-related admissions (Broad). Admissions to hospital where the primary diagnosis is an alcohol-related condition, or a secondary diagnosis is an alcohol-related external cause. More specifically, hospital admissions records are identified where the admission is a finished episode [epistat = 3]; the admission is an ordinary admission, day case or maternity [classpat = 1, 2 or 5]; it is an admission episode [epiorder = 1]; the sex of the patient is valid [sex = 1 or 2]; there is a valid age at start of episode [startage between 0 and 150 or between 7001 and 7007]; the region of residence is one of the English regions, no fixed abode or unknown [resgor <= K or U or Y]; the episode end date [epiend] falls within the financial year, and an alcohol-attributable ICD10 code appears in the primary diagnosis field [diag_01] or an alcohol-related external cause code appears in any diagnosis field [diag_nn]. For each episode identified, an alcohol-attributable fraction is applied to the primary diagnosis field or an alcohol-attributable external cause code appears in one of the secondary codes based on the diagnostic codes, age group, and sex of the patient. Where there is more than one alcohol-related ICD10 code among the 20 possible diagnostic codes, the code with the largest alcohol-attributable fraction is selected; in the event of there being two or more codes with the same alcohol-attributable fraction within the same episode, the one from the lowest diagnostic position is selected. For a detailed list of all alcohol-attributable diseases, including ICD 10 codes and relative risks, see ‘Alcohol-attributable fractions for England: an update’ (2). Alcohol-related hospital admission episodes were extracted from HES according to the Broad definition and admissions flagged as either elective or non-elective based on the admission method field. The cost of each admission episode was calculated using the [National Cost Collection] (published by NHS England) main schedule dataset for the corresponding financial year applied to elective and non-elective admission episodes. The healthcare resource group (HRG) was identified using the HES field SUSHRG [SUS Generated HRG], which is the SUS PbR derived HRG code at episode level. Healthcare Resource Groups (HRGs) are standard groupings of clinically similar treatments which use common levels of healthcare resource. The elective admissions were assigned an average of the elective and day-case costs. The non-electives were assigned an average of the non-elective long stay and non-elective short stay costs. Where the HRG was not available or did not match the National Reference Costs look-up table, an average elective or non-elective cost was imputed. This may result in the cost of these admissions being underestimated. For each record, the AAF was multiplied by the reference cost and the resulting values were aggregated by the required output geographies to provide numerators for the cost per capita indicator. References: (2) PHE (2020) Alcohol-attributable fractions for England: an update [https://www.gov.uk/government/publications/alcohol-attributable-fractions-for-england-an-update] ## Definition of denominator Mid-year population estimates. ## Caveats Not all alcohol-related conditions require inpatient services, so this indicator is only one measure of the alcohol-related health problems in each local area. However, inpatient admissions are easily monitored, and this indicator provides local authorities with a routine method of monitoring the health impacts of alcohol in their local populations. The Healthcare Resource Group cost assigned to each hospital admission is for the initial admission episode only and doesn’t include costs related to alcohol in any subsequent episodes in the hospital spell. Where the HRG was not available or did not match the National Reference Costs look-up table, an average elective or non-elective cost was imputed. This may result in the cost of these admissions being underestimated. It must be noted that the numerator is based on the financial year and the denominator on calendar mid-year population estimates, e.g., 2019/20 admission rates are constructed from admission counts for the 2019/20 financial year and mid-year population estimates for the 2020 calendar year. Data for England includes records with geography 'No fixed abode'. Alcohol-attributable fractions were not available for children. Conditions where low levels of alcohol consumption are protective (have a negative alcohol-attributable fraction) are not included in the calculation of the indicator. This does not include attendance at Accident and Emergency departments. Hospital Episode Statistics overall is well completed. However, year-on-year variations exist due to poor completion from a proportion of trusts. Analysis has revealed significant differences across the country in the coding of cancer patients in the Hospital Episode Statistics. In particular, in some areas, regular attenders at hospital for treatments like chemotherapy and radiotherapy are being incorrectly recorded as ordinary or day-case admissions. Since cancer admissions form part of the overarching alcohol-related admission national indicators, the inconsistent recording across the country for cancer patients has some implication for these headline measures. Cancer admissions make up approximately a quarter of the total number of alcohol-related admissions. Analysis suggests that, although most Local Authorities would remain within the same RAG group compared with the England average if cancer admissions were removed, the ranking of Local Authorities within RAG groups would be altered. We are continuing to monitor the impact of this issue and to consider ways of improving the consistency between areas. The COVID-19 pandemic had a large impact on hospital activity with a reduction in admissions in 2020 to 2021. Because of this, NHS Digital has been unable to analyse coverage (measured as the difference between expected and actual records submitted by NHS Trusts) in the normal way. There may have been issues around coverage in some areas which were not identified as a result.