Estimating the cost-effectiveness of needle-syringe programs in Australia

Kwon, Jisoo; Anderson, J.; Kerr, Cliff C.; Thein, Hla-Hla; Zhang, Lei; Iversen, Jenny; Dore, Gregory J.; Kaldor, John; Law, Matthew; Maher, Lisa; Wilson, David

doi:10.1097/qad.0b013e3283578b5d

Cited by 85 publications

(61 citation statements)

References 28 publications

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“…Other models have looked at the impact of NSP or OST on HCV infection transmission, but have generally lacked empirical efficacy estimates for the effect of these interventions on HCV infection acquisition risk, 79,[112][113][114] or have not considered impact in specific cities parameterised with detailed data. 86 Our modelling extends existing analyses by including detailed context-specific modelling of the impact of OST, NSP and HCV infection treatment, as well as the disabling effect of high-risk behaviours and how it varies across UK settings.…”

Section: Other Evidence and Implicationsmentioning

confidence: 99%

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

et al. 2017

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Background There is limited evidence of the impact of needle and syringe programmes (NSPs) and opioid substitution therapy (OST) on hepatitis C virus (HCV) incidence among people who inject drugs (PWID), nor have there been any economic evaluations. Objective(s) To measure (1) the impact of NSP and OST, (2) changes in the extent of provision of both interventions, and (3) costs and cost-effectiveness of NSPs on HCV infection transmission. Design We conducted (1) a systematic review; (2) an analysis of existing data sets, including collating costs of NSPs; and (3) a dynamic deterministic model to estimate the impact of differing OST/NSP intervention coverage levels for reducing HCV infection prevalence, incidence and disease burden, and incremental cost-effectiveness ratios to measure the cost-effectiveness of current NSP provision versus no provision. Setting Cost-effectiveness analysis and impact modelling in three UK sites. The pooled analysis drew on data from the UK and Australia. The review was international. Participants PWID. Interventions NSP coverage (proportion of injections covered by clean needles) and OST. Outcome New cases of HCV infection. Results The review suggested that OST reduced the risk of HCV infection acquisition by 50% [rate ratio (RR) 0.50, 95% confidence interval (CI) 0.40 to 0.63]. Weaker evidence was found in areas of high (≥ 100%) NSP coverage (RR 0.77, 95% CI 0.38 to 1.54) internationally. There was moderate evidence for combined high coverage of NSPs and OST (RR 0.29, 95% CI 0.13 to 0.65). The pooled analysis showed that combined high coverage of NSPs and OST reduced the risk of HCV infection acquisition by 29–71% compared with those on minimal harm reduction (no OST, ≤ 100% NSP coverage). NSPs are likely to be cost-effective and are cost-saving in some settings. The impact modelling suggest that removing OST (current coverage 81%) and NSPs (coverage 54%) in one site would increase HCV infection incidence by 329% [95% credible interval (CrI) 110% to 953%] in 2031 and at least double (132% increase; 95% CrI 51% to 306%) the number of new infections over 15 years. Increasing NSP coverage to 80% has the largest impact in the site with the lowest current NSP coverage (35%), resulting in a 27% (95% CrI 7% to 43%) decrease in new infections and 41% (95% CrI 11% to 72%) decrease in incidence by 2031 compared with 2016. Addressing homelessness and reducing the harm associated with the injection of crack cocaine could avert approximately 60% of HCV infections over the next 15 years. Limitations Findings are limited by the misclassification of NSP coverage and the simplified intervention definition that fails to capture the integrated services that address other social and health needs as part of this. Conclusions There is moderate evidence of the effectiveness of OST and NSPs, especially in combination, on HCV infection acquisition risk. Policies to ensure that NSPs can be accessed alongside OST are needed. NSPs are cost-saving in some sites and cost-effective in others. NSPs and OST are likely to prevent considerable rates of HCV infection in the UK. Increasing NSP coverage will have most impact in settings with low coverage. Scaling up other interventions such as HCV infection treatment are needed to decrease epidemics to low levels in higher prevalence settings. Future work To understand the mechanisms through which NSPs and OST achieve their effect and the optimum contexts to support implementation. Funding The National Institute for Health Research Public Health Research programme.

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Section: Other Evidence and Implicationsmentioning

confidence: 99%

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

et al. 2017

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“…This suggests that stigma and discrimination and its impact on clients' mental health need to be acknowledged and addressed within NSP settings. Hence, these results challenge the emphasis of NSP operations on a narrow focus of equipment distribution only (Kwon et al, 2009(Kwon et al, , 2012.…”

Section: Discussionmentioning

confidence: 90%

Perceived discrimination and injecting risk among people who inject drugs attending Needle and Syringe Programmes in Sydney, Australia

Wilson

Brener

Mao

et al. 2014

Drug and Alcohol Dependence

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“…Injecting drug use is the primary mode of HCV transmission in Australia and New Zealand 10 and needle and syringe exchange programs and opioid substitution therapy have proven efficacy for HCV primary prevention amongst people who inject drugs [11][12][13][14] (Source: Return on Investment of Needle and Exchange Programs in Australia: Summary Report. http://www.health.gov.au/internet/ main/publishing.nsf/Content/9610691C9FBD7966CA25 7BF0001E37EF/$File/roisum.pdf; accessed 24 November 2014).…”

Section: Discussionmentioning

confidence: 99%

The increasing burden of potentially preventable liver disease among adult liver transplant recipients: A comparative analysis of liver transplant indication by era in Australia and New Zealand

Howell

Balderson

Hellard

et al. 2016

J of Gastro and Hepatol

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Since 2004, the majority of primary adult liver transplants within Australia and New Zealand have been because of potentially preventable liver diseases and the prevalence of these diseases has increased over time. This finding represents an opportunity for clinicians to make a significant impact on the overall burden of advanced liver disease in Australia and New Zealand by improving primary and secondary prevention measures.

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Estimating the cost-effectiveness of needle-syringe programs in Australia

Abstract: Australia's early introduction and high coverage of NSPs has significantly reduced the prevalence of HIV and HCV among IDUs. NSPs are a cost-effective public health strategy and will result in substantial net cost savings in the future.

Cited by 85 publications

References 28 publications

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

Perceived discrimination and injecting risk among people who inject drugs attending Needle and Syringe Programmes in Sydney, Australia

The increasing burden of potentially preventable liver disease among adult liver transplant recipients: A comparative analysis of liver transplant indication by era in Australia and New Zealand

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