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The cost-effectiveness of Vancouver's supervised injection facility.

https://arctichealth.org/en/permalink/ahliterature154177
Source
CMAJ. 2008 Nov 18;179(11):1143-51
Publication Type
Article
Date
Nov-18-2008
Author
Ahmed M Bayoumi
Gregory S Zaric
Author Affiliation
The Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. ahmed.bayoumi@utoronto.ca
Source
CMAJ. 2008 Nov 18;179(11):1143-51
Date
Nov-18-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
British Columbia
Communicable Disease Control - economics
Cost Savings
Cost-Benefit Analysis
Female
HIV Infections - epidemiology - prevention & control
Health Care Costs
Hepatitis C - epidemiology - prevention & control
Humans
Male
Middle Aged
Models, Economic
Needle Sharing - economics
Needle-Exchange Programs - economics - organization & administration
Quality-Adjusted Life Years
Sensitivity and specificity
Substance Abuse, Intravenous - drug therapy - economics
Urban Population
Young Adult
Abstract
The cost-effectiveness of Canada's only supervised injection facility has not been rigorously evaluated. We estimated the impact of the facility on survival, rates of HIV and hepatitis C virus infection, referral to methadone maintenance treatment and associated costs.
We simulated the population of Vancouver, British Columbia, including injection drug users and persons infected with HIV and hepatitis C virus. The model used a time horizon of 10 years and the perspective of the health care system. We compared the situation of the supervised injection facility with one that had no facility but that had other interventions, such as needle-exchange programs. The effects considered were decreased needle sharing, increased use of safe injection practices and increased referral to methadone maintenance treatment. Outcomes included life-years gained, costs, and incremental cost-effectiveness ratios discounted at 5% per year.
Focusing on the base assumption of decreased needle sharing as the only effect of the supervised injection facility, we found that the facility was associated with an incremental net savings of almost $14 million and 920 life-years gained over 10 years. When we also considered the health effect of increased use of safe injection practices, the incremental net savings increased to more than $20 million and the number of life-years gained to 1070. Further increases were estimated when we considered all 3 health benefits: the incremental net savings was more than $18 million and the number of life-years gained 1175. Results were sensitive to assumptions related to injection frequency, the risk of HIV transmission through needle sharing, the frequency of safe injection practices among users of the facility, the costs of HIV-related care and of operating the facility, and the proportion of users who inject in the facility.
Vancouver's supervised injection site is associated with improved health and cost savings, even with conservative estimates of efficacy.
Notes
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Comment In: CMAJ. 2008 Nov 18;179(11):1105-619015552
PubMed ID
19015565 View in PubMed
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Effectiveness and cost-effectiveness of strategies to expand antiretroviral therapy in St. Petersburg, Russia.

https://arctichealth.org/en/permalink/ahliterature166730
Source
AIDS. 2006 Nov 14;20(17):2207-15
Publication Type
Article
Date
Nov-14-2006
Author
Elisa F Long
Margaret L Brandeau
Cristina M Galvin
Tatyana Vinichenko
Swati P Tole
Adam Schwartz
Gillian D Sanders
Douglas K Owens
Author Affiliation
Department of Management Science and Engineering, Stanford University, Stanford, CA 94305, USA. elisa46@stanford.edu
Source
AIDS. 2006 Nov 14;20(17):2207-15
Date
Nov-14-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antiretroviral Therapy, Highly Active - economics
Cost-Benefit Analysis
HIV Infections - drug therapy - economics - transmission
Humans
Middle Aged
Prevalence
Quality-Adjusted Life Years
Russia - epidemiology
Substance Abuse, Intravenous - drug therapy - economics
Abstract
To assess the effectiveness and cost-effectiveness of treating HIV-infected injection drug users (IDUs) and non-IDUs in Russia with highly active antiretroviral therapy HAART.
A dynamic HIV epidemic model was developed for a population of IDUs and non-IDUs. The location for the study was St. Petersburg, Russia. The adult population aged 15 to 49 years was subdivided on the basis of injection drug use and HIV status. HIV treatment targeted to IDUs and non-IDUs, and untargeted treatment interventions were considered. Health care costs and quality-adjusted life years (QALYs) experienced in the population were measured, and HIV prevalence, HIV infections averted, and incremental cost-effectiveness ratios of different HAART strategies were calculated.
With no incremental HAART programs, HIV prevalence reached 64% among IDUs and 1.7% among non-IDUs after 20 years. If treatment were targeted to IDUs, over 40 000 infections would be prevented (75% among non-IDUs), adding 650 000 QALYs at a cost of USD 1501 per QALY gained. If treatment were targeted to non-IDUs, fewer than 10 000 infections would be prevented, adding 400 000 QALYs at a cost of USD 2572 per QALY gained. Untargeted strategies prevented the most infections, adding 950 000 QALYs at a cost of USD 1827 per QALY gained. Our results were sensitive to HIV transmission parameters.
Expanded use of antiretroviral therapy in St. Petersburg, Russia would generate enormous population-wide health benefits and be economically efficient. Exclusively treating non-IDUs provided the least health benefit, and was the least economically efficient. Our findings highlight the urgency of initiating HAART for both IDUs and non-IDUs in Russia.
PubMed ID
17086061 View in PubMed
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