title: Comparing the cost effectiveness of harm reduction strategies: a case study of the Ukraine.
abstract: BACKGROUND
  Harm reduction strategies commonly include needle and syringe programmes (NSP), opioid substitution therapy (OST) and interventions combining these two strategies. Despite the proven effectiveness of harm-reduction strategies in reducing human immunodeficiency virus (HIV) infection among injecting drug users (IDUs), no study has compared the cost-effectiveness of these interventions, nor the incremental cost effectiveness of combined therapy. Using data from the Global Fund, this study compares the cost-effectiveness of harm reduction strategies in Eastern Europe and Central Asia, using the Ukraine as a case study.
  
  
  METHODS
  A Markov Monte Carlo simulation is carried out using parameters from the literature and cost data from the Global Fund. Effectiveness is presented as both QALYs and infections averted. Costs are measured in 2011 US dollars.
  
  
  RESULTS
  The Markov Monte Carlo simulation estimates the cost-effectiveness ratio per infection averted as $487.4 [95% CI: 488.47-486.35] in NSP and $1145.9 [95% CI: 1143.39-1148.43] in OST. Combined intervention is more costly but more effective than the alternative strategies with a cost effectiveness ratio of $851.6[95% CI: 849.82-853.55]. The ICER of the combined strategy is $1086.9/QALY [95% CI: 1077.76:1096.24] compared with NSP, and $461.0/infection averted [95% CI: 452.98:469.04] compared with OST. These results are consistent with previous studies.
  
  
  CONCLUSIONS
  Despite the inherent limitations of retrospective data, this study provides evidence that harm-reduction interventions are a cost-effective way to reduce HIV prevalence. More research on into cost effectiveness in different settings, and the availability of fiscal space for government uptake of programmes, is required.
authors: UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH UK.
authors: Sung Wook
authors: SW
authors: Kim
authors: UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH UK ; Epidemiology and Global Health Department, Umeå University, Umea, Sweden.
authors: Anni-Maria
authors: AM
authors: Pulkki-Brannstrom
authors: UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH UK ; London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.
authors: Jolene
authors: J
authors: Skordis-Worrall
keywords: Cost effectiveness analysis; Global Fund; Harm reduction; Markov Monte Carlo simulation; Needle and syringe programme; Opioid substitution therapy; Ukraine