A cost-benefit/cost-effectiveness analysis of an unsanctioned supervised smoking facility in the Downtown Eastside of Vancouver, Canada.
BACKGROUND
Smoking crack involves the risk of transmitting diseases such as HIV and hepatitis C (HCV). The current study determines whether the formerly unsanctioned supervised smoking facility (SSF)-operated by the grassroot organization, Vancouver Area Network of Drug Users (VANDU) for the last few years-costs less than the costs incurred for health-care services as a direct consequence of not having such a program in Vancouver, Canada.


METHODS
The data pertaining to the attendance at the SSF was gathered in 2012-2013 by VANDU. By relying on this data, a mathematical model was employed to estimate the number of HCV infections prevented by the former facility in Vancouver's Downtown Eastside (DTES).


RESULTS
The DTES SSF's benefit-cost ratio was conservatively estimated at 12.1:1 due to its low operating cost. The study used 70% and 90% initial pipe-sharing rates for sensitivity analysis. At 80% sharing rate, the marginal HCV cases prevented were determined to be 55 cases. Moreover, at 80% sharing rate, the marginal cost-effectiveness ratio ranges from $1,705 to $97,203. The results from both the baseline and sensitivity analysis demonstrated that the establishment of the SSF by VANDU on average had annually saved CAD$1.8 million dollars in taxpayer's money.


CONCLUSIONS
Funding SSFs in Vancouver is an efficient and effective use of financial resources in the public health domain; therefore, Vancouver Coastal Health should actively participate in their establishment in order to reduce HCV and other blood-borne infections such as HIV within the non-injecting drug users.
School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada. eja2@sfu.ca.
Ehsan
E
Jozaghi
D002170:Canada; D019970:Cocaine-Related Disorders / Q000191:economics*; D003140:Communicable Disease Control / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis / Q000379:methods* / Q000706:statistics & numerical data; D016578:Crack Cocaine / Q000191:economics*; D040261:Harm Reduction; D006801:Humans; D019037:Urban Health Services / Q000191:economics*
D016578:Crack Cocaine