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Needle & syringe programs proven cost effective |
In 2000, the Commonwealth Department of Health commissioned a study into the economic effectiveness of needle and syringe programs in Australia, which has proven needle and syringe programs to be cost effective.
The study updated and expanded a previous study by Hurley, Jolley & Kaldor, which had researched the effectiveness and cost effectiveness of needle and syringe programs in relation to HIV/AIDS. It sought to analyse the effectiveness of needle and syringe programs in preventing transmission of HIV and HCV in Australia from 1991 (ie. from when needle and syringe programs were well established in all jurisdictions except Tasmania) to the end of 2000. The study then used these findings to calculate the return on investment from these programs from 1991-2000.
The total HIV treatment costs avoided over the lifetime of estimated cases are estimated at $7,025 million. These represent the savings that accrue from about 25,000 cases of HIV avoided, who would have lived for an average of 24 years after infection, and who would have incurred average treatment costs of nearly $14,000 each year of their life after diagnosis.
The total HCV treatment costs avoided over the life of cases are estimated at $783 million (21,000 estimated cases).
Hence, the total treatment costs avoided over the life of the cases of HIV and HCV avoided by needle and syringe programs are about $7,808 million.
The study showed the return on investment greatly exceeded the original investment in the program and also that the original investment was fully recouped and surpassed by the end of the investment period, before any future savings were taken into account.
Quality of life
The application of an adjustment factor to the number of life years gained to take account of the quality of life effects of these diseases leads to a measure referred to as quality adjusted life years (QALYs).
QALYs gained by avoiding HIV and HCV incorporate both the quantity and the quality of life gained. The analysis demonstrates that needle and syringe programs have contributed significantly to:
- The number of cases of HIV and HCV avoided;
- A reduction in the number of deaths from HIV, and to a lesser extent from HCV;
- An increase in the number of life years among injecting drug users, particularly from the avoidance of HIV;
- An improvement in the quality of life among injecting drug users who would otherwise have contracted HIV or HCV.
The estimated 25,000 persons avoiding HIV are expected to gain an additional 715,000 QALYs than if they had contracted the disease. In comparison, the estimated 21,000 persons avoiding HCV are expected to gain about 120,000 QALYs over their lifetime.
The study into the effect of needle and syringe programs on HIV and HCV and the consequent return on investment from these programs has reinforced the original findings by Hurley, Jolley and Kaldor. The results demonstrate that these programs are effective in reducing the incidence of both diseases and that they represent an effective financial investment by government. The consideration of effect has been limited to the future benefits accruing from the cases of HIV and HCV avoided during the investment period (1990s).
“The results demonstrate that, across all measures of effect used in the study, needle and syringe programs have yielded a significant public health benefit, and that continued investment is warranted from both a financial and human perspective.”
Gareth Daniels is the division’s drug and alcohol project officer.
References:
The return on investment in needle & syringe programs, Final Report, Health Outcomes International in association with the National Centre for HIV Epidemiology and Clinical Research http://www.drugpolicy.org/docUploads/ROIfinal.pdf
Hurley, Jolley & Kaldor, An economic evaluation of aspects of the Australian HIV/AIDS strategies
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