Cost-effectiveness of harm reduction in preventing hepatitis C among injection drug users.
OBJECTIVE
Hepatitis C (HCV) has emerged as a major epidemic among injection drug users (IDUs), with observed prevalence exceeding 70% in many American and European cities. This article explores the potential of syringe exchange programs (SEPs) to reduce HCV incidence and prevalence.


METHODS
A random-mixing epidemiological model is used to examine the potential impact of harm reduction interventions.


METHODS
Steady-state analysis is used to scrutinize the impact of SEP on HCV incidence and prevalence and to examine the accuracy of short-term incidence analysis in predicting long-run program effects.


RESULTS
SEP is predicted to have little impact on HCV incidence and prevalence within realistic populations of IDUs.


CONCLUSIONS
Short-term incidence analysis substantially overstates SEP effectiveness and cost-effectiveness in preventing HCV. More comprehensive harm reduction models, coupled with referral of active IDUs to treatment, must complement syringe exchange to successfully contain highly infectious blood-borne diseases.
Pollack
H A
HA
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor 48109-2029, USA. haroldp@sph.umich.edu
D017848:Blood-Borne Pathogens; D003362:Cost-Benefit Analysis; D015987:Effect Modifier, Epidemiologic; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D017048:Health Care Costs; D006526:Hepatitis C / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D017059:Models, Econometric; D016485:Needle Sharing / Q000191:economics; D018671:Needle-Exchange Programs / Q000191:economics*; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000821:virology*