Needle exchange programs: an economic evaluation of a local experience.
OBJECTIVE
To determine whether providing a needle exchange program to prevent HIV transmission among injection drug users would cost less than the health care consequences of not having such a program.


METHODS
Incidence outcome model to estimate the number of cases of HIV infection that this program would prevent over 5 years, assuming that the HIV incidence rate would be 2% with the program and 4% without it, and that an estimated 275 injection drug users would use the service over this time.


METHODS
Hamilton, Ont.


METHODS
Estimated number of cases of HIV infection expected to be prevented with and without the program over 5 years; estimated lifetime health care costs of treating an AIDS patient. The indirect costs of AIDS to society (e.g., lost productivity and informal caregiving) were not included. Projected costs were adjusted (discounted) to reflect their present value. In a sensitivity analysis, 3 parameters were varied: the estimate of the HIV transmission rate if no needle exchange program were provided, the number of injection drug users participating in the program, and the discount rate.


RESULTS
With very conservative estimates, it was predicted that the Hamilton needle exchange program will prevent 24 cases of HIV infection over 5 years, thereby providing cost savings of $1.3 million after the program costs are taken into account. This translates into a ratio of cost savings to costs of 4:1. The sensitivity analysis confirmed that these findings are robust.


CONCLUSIONS
Needle exchange programs are an efficient use of financial resources.
Gold
M
M
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont.
Gafni
A
A
Nelligan
P
P
Millson
P
P
D002170:Canada; D017046:Cost Savings; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D015994:Incidence; D018671:Needle-Exchange Programs / Q000191:economics*; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D015819:Substance Abuse, Intravenous / Q000150:complications