A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Montreal, Canada

Abstract

BackgroundThis paper will determine whether expanding Insite (North America’s first and only supervised injection facility) to more locations in Canada such as Montreal, cost less than the health care consequences of not having such expanded programs for injection drug users.MethodsBy analyzing secondary data gathered in 2012, this paper relies on mathematical models to estimate the number of new HIV and Hepatitis C (HCV) infections prevented as a result of additional SIF locations in Montreal.ResultsWith very conservative estimates, it is predicted that the addition of each supervised injection facility (up-to a maximum of three) in Montreal will on average prevent 11 cases of HIV and 65 cases of HCV each year. As a result, there is a net cost saving of CDN$0.686 million (HIV) and CDN$0.8 million (HCV) for each additional supervised injection site each year. This translates into a net average benefit-cost ratio of 1.21: 1 for both HIV and HCV.ConclusionsFunding supervised injection facilities in Montreal appears to be an efficient and effective use of financial resources in the public health domain.

Examining the potential role of a supervised injection facility in Saskatoon, Saskatchewan, to avert HIV among people who inject drugs

“…A recent study conducted in Montreal estimated the number of HIV and HCV cases averted with the opening of a potential SIF in the city (19). Expected fiscal savings amounted to more than three million Canadian dollars in HIV and HCV prevention (19). In a similar study conducted in Ottawa, the effects of opening a SIF in the city were examined (10).…”

“…Previous costing studies have illustrated that SIF prevent shared or 'dirty' injections (10,(15)(16)(17)(18)(19)28,29). Behavioral changes for those who attend SIF has been highlighted as an important factor in previous literature as well (30,31).…”

“…Later, the model was used in an economic evaluation of Insite (14)(15)(16)(17)(18)25,26). In addition, the model has been used to estimate the cost-benefit/cost-effectiveness of a SIF potential in Montreal, Quebec, and Ottawa, Ontario (10,19). The model has been employed to assess the economic viability of a supervised smoking facility in the DTES of Vancouver (20).…”

“…The data for both mathematical models were collected from published and peer-reviewed articles (see Table 1). To reduce selection bias, the values and parameters that were the most conservative in their reporting were selected (10,17,19,20,26). In addition, preferences were given to peer-reviewed studies when other sources were available.…”

“…Further studies have assessed the cost-effectiveness of opening a SIF in Montreal, Ottawa and other drug affected regions in Canada. A recent study conducted in Montreal estimated the number of HIV and HCV cases averted with the opening of a potential SIF in the city (19). Expected fiscal savings amounted to more than three million Canadian dollars in HIV and HCV prevention (19).…”