Syringe exchange in the United States: a national level economic evaluation of hypothetical increases in investment.
To examine whether increasing investment in needle/syringe exchange programs (NSPs) in the US would be cost-effective for HIV prevention, we modeled HIV incidence in hypothetical cases with higher NSP syringe supply than current levels, and estimated number of infections averted, cost per infection averted, treatment costs saved, and financial return on investment. We modified Pinkerton's model, which was an adaptation of Kaplan's simplified needle circulation theory model, to compare different syringe supply levels, account for syringes from non-NSP sources, and reflect reduction in syringe sharing and contamination. With an annual $10 to $50 million funding increase, 194-816 HIV infections would be averted (cost per infection averted $51,601-$61,302). Contrasted with HIV treatment cost savings alone, the rate of financial return on investment would be 7.58-6.38. Main and sensitivity analyses strongly suggest that it would be cost-saving for the US to invest in syringe exchange expansion.
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, nqtrang.hanoi@gmail.com.
Trang Quynh
TQ
Nguyen
Brian W
BW
Weir
Don C
DC
Des Jarlais
Steven D
SD
Pinkerton
David R
DR
Holtgrave
D017046:Cost Savings / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D018803:Models, Economic; D018671:Needle-Exchange Programs / Q000191:economics* / Q000379:methods; D015819:Substance Abuse, Intravenous / Q000191:economics / Q000453:epidemiology; D014481:United States / Q000453:epidemiology