Health and economic burden due to alcohol-associated liver diseases in the Union Territory of Delhi: A Markov probabilistic model approach

Archana Ramalingam; Samba Siva Rao Pasupuleti; Bharathnag Nagappa; Shiv Kumar Sarin

doi:10.1007/s12664-021-01221-4

Health and economic burden due to alcohol-associated liver diseases in the Union Territory of Delhi: A Markov probabilistic model approach

Indian J Gastroenterol. 2022 Feb;41(1):84-95. doi: 10.1007/s12664-021-01221-4. Epub 2022 Feb 28.

Authors

Archana Ramalingam^{1

2}, Samba Siva Rao Pasupuleti^{1

3}, Bharathnag Nagappa¹, Shiv Kumar Sarin⁴

Affiliations

¹ Department of Epidemiology and Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India.
² National Institute of Epidemiology, Chennai, India.
³ Department of Statistics, Mizoram University, Pachhunga University College Campus, Aizawl, 796 001, India.
⁴ Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India. sksarin@ilbs.in.

PMID: 35226293
DOI: 10.1007/s12664-021-01221-4

Abstract

Background: Nearly one-fifth of all deaths attributable to alcohol are due to liver diseases.

Methods: The study employs a Markov Probabilistic Modeling approach considering various clinical spectrum of alcohol-associated liver diseases (ALD), to gauge the health and economic burden due to ALD for the national capital territory of Delhi, from March 2017 to February 2018. The health impact was estimated through Disability Adjusted Life Years (DALYs), years of life lost (YLL), and total deaths due to ALD. The economic burden of ALD was assessed assuming the current health-seeking preferences and assuming that all the diseased individuals are cared for in the public health systems. Sensitivity analysis was done by Monte Carlo simulations.

Results: Total number of estimated deaths due to ALD in the national capital territory of Delhi for one year period from March 2017 was 8367. The DALYs due to ALD were estimated to be 0.247 million life years; this includes 0.178 million YLL and 0.069 million life years lost due to disability. The total cost of treating ALD was estimated to be 92.94 billion Indian rupees, if patients sought care based on current preferences and 55.52 billion Indian rupees if all diseased individuals were cared for in public health systems. The total excise revenue due to alcohol to the Government is being Indian rupees 43.1 billion in the said year.

Conclusion: The high burden of ALD in terms of lives lost, DALYs lost, and more than two times higher estimated expense for care than the revenue generation due to alcohol clearly indicates that it would be prudent to initiate social engineering and preventive strategies to lessen the growing burden of ALD in India. The Delhi model for health and economic burden of ALD could help the country develop policies for better health outcomes of these patients.

Keywords: Alcoholism; Cost of illness; Cost savings; Health expenditure; Life expectancies; Liver diseases, alcoholic; Models, economic; Mortality; Organization and administration; Primary health care; Quality-adjusted life years; Years of potential life lost.

MeSH terms

Cost of Illness
Financial Stress*
Humans
India / epidemiology
Models, Statistical*
Quality-Adjusted Life Years