{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T12:28:17Z","timestamp":1776083297798,"version":"3.50.1"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["R01AA028224"],"award-info":[{"award-number":["R01AA028224"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Canadian Institutes of Health Research via the Ontario Canadian Research Initiative Node Team (OCRINT) CRISM Phase II","award":["CIHR FRN-181677"],"award-info":[{"award-number":["CIHR FRN-181677"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Estonia is planning an update of its national alcohol policies where an economic return on investment (ROI) analysis is needed to guide decisions against their monetary returns. Using mostly national data sources, the ROI analysis was based on direct healthcare costs and productivity losses due to premature mortality. The interventions compared comprised availability restrictions and taxation increases. For taxation increases, associated revenue increases to government were included. All analyses used a one-year time horizon and different sensitivity analyses. In 2023, all alcohol-attributable harms in Estonia totalled \u20ac510.00 million (1.3% of the Gross Domestic Product of Estonia) with \u20ac263.91 million direct costs and \u20ac246.08 million indirect costs. The proposed availability reductions are expected to yield a net benefit of \u20ac6.33 million, whereas a 15% increase in alcohol excise taxation could lower healthcare costs and productivity losses by \u20ac1.77 million in addition to increasing tax revenue by \u20ac32.27 million. Moreover, the interventions were estimated to lead to substantial reductions in mortality and hospitalizations. In terms of ROI, the availability interventions would result in \u20ac15 gained for each euro invested, and the taxation increase in \u20ac477 per euro invested, and without revenue in \u20ac25 per euro invested. Positive ROI was also shown in all sensitivity analyses. The proposed alcohol control policies for Estonia would not only reduce mortality and morbidity but also bring sizeable gains for each euro invested. Higher ROI for taxation increase compared to availability restrictions was mainly due to the added tax revenue.<\/jats:p>","DOI":"10.1093\/eurpub\/ckaf265","type":"journal-article","created":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T12:30:49Z","timestamp":1767529849000},"source":"Crossref","is-referenced-by-count":1,"title":["Using a return on investment analysis to estimate the economic impact of potential changes to alcohol control policies in Estonia"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5444-1560","authenticated-orcid":false,"given":"Pol","family":"Rovira","sequence":"first","affiliation":[{"name":"Program on Substance Abuse & WHO European Region Collaboration Centre, Public Health Agency of Catalonia , Barcelona, Catalonia,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4475-0378","authenticated-orcid":false,"given":"Taavi","family":"Lai","sequence":"additional","affiliation":[{"name":"Fourth View Consulting , Tallinn,","place":["Estonia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9488-887X","authenticated-orcid":false,"given":"Rainer","family":"Reile","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, National Institute for Health Development , Tallinn,","place":["Estonia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8878-5567","authenticated-orcid":false,"given":"Ahmed S","family":"Hassan","sequence":"additional","affiliation":[{"name":"Centre for Addiction and Mental Health, Institute for Mental Health Policy Research , Toronto, ON,","place":["Canada"]},{"name":"Dalla Lana School of Public Health, University of Toronto , Toronto, ON,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5665-0385","authenticated-orcid":false,"given":"J\u00fcrgen","family":"Rehm","sequence":"additional","affiliation":[{"name":"Program on Substance Abuse & WHO European Region Collaboration Centre, Public Health Agency of Catalonia , Barcelona, Catalonia,","place":["Spain"]},{"name":"Centre for Addiction and Mental Health, Institute for Mental Health Policy Research , Toronto, ON,","place":["Canada"]},{"name":"Dalla Lana School of Public Health, University of Toronto , Toronto, ON,","place":["Canada"]},{"name":"Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto, ON,","place":["Canada"]},{"name":"PAHO\/WHO Collaborating Centre at Centre for Addiction and Mental Health , Toronto, ON,","place":["Canada"]},{"name":"Department of Psychiatry, Faculty of Medicine, University of Toronto , Toronto, ON,","place":["Canada"]},{"name":"Faculty of Medicine, Institute of Medical Science, University of Toronto , Toronto, ON,","place":["Canada"]},{"name":"Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE) , Hamburg,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"key":"2026040911314264100_ckaf265-B1","doi-asserted-by":"publisher","first-page":"e751","DOI":"10.1016\/S2468-2667(25)00174-4","article-title":"National, regional, and global statistics on alcohol consumption and the resulting burdens of disease 2000\u20132020: a comparative risk assessment study","volume":"10","author":"Shield","year":"2025","journal-title":"Lancet Public Health"},{"key":"2026040911314264100_ckaf265-B2","volume-title":"Alcohol: No Ordinary Commodity\u2014Research and Public Policy","author":"Babor","year":"2023","edition":"3rd ed"},{"key":"2026040911314264100_ckaf265-B3","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1007\/s40273-021-01031-8","article-title":"What are the economic costs to society attributable to alcohol use? 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