Syringe Exchange in the United States: A National Level Economic Evaluation of Hypothetical Increases in Investment
To examine whether increasing investment in needle/syringe exchange programs (NSPs) in the US would be cost-effective for HIV prevention, we modeled HIV incidence in hypothetical cases with higher NSP syringe supply than current levels, and estimated number of infections averted, cost per infection averted, treatment costs saved, and financial return on investment. We modified Pinkerton’s model, which was an adaptation of Kaplan’s simplified needle circulation theory model, to compare different syringe supply levels, account for syringes from non-NSP sources, and reflect reduction in syringe sharing and contamination. With an annual $10 to $50 million funding increase, 194–816 HIV infections would be averted (cost per infection averted $51,601–$61,302). Contrasted with HIV treatment cost savings alone, the rate of financial return on investment would be 7.58–6.38. Main and sensitivity analyses strongly suggest that it would be cost-saving for the US to invest in syringe exchange expansion.
KeywordsCost-effectiveness Mathematical model Syringe exchange Injection drug use HIV
- 3.Hutchinson AB, Patel P, Sansom SL, Farnham PG, Sullivan TJ, Bennett B, et al. Cost-effectiveness of pooled nucleic acid amplification testing for acute HIV infection after third-generation HIV antibody screening and rapid testing in the United States: a comparison of three public health settings. PLoS Med. 2010;7:e1000342.PubMedCrossRefPubMedCentralGoogle Scholar
- 4.Centers for Disease Control and Prevention. HIV cost-effectiveness. http://www.cdc.gov/hiv/prevention/ongoing/costeffectiveness. 2014. Retrieved 2014 Apr 19.
- 6.Office of National AIDS Policy. National HIV/AIDS Strategy for the United States. 2010. http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf.
- 7.Gold M, Gafni A, Nelligan P, Millson P. Needle exchange programs: an economic evaluation of a local experience. Can Med Assoc J. 1997;157:255–62.Google Scholar
- 15.The Office of the Global AIDS Coordinator. PEPFAR blueprint: creating an AIDS-free generation. 2012. http://www.pepfar.gov/documents/organization/201386.pdf.
- 16.National Center for HIV/AIDS, Viral Hepatitis S and TP. Strategic Plan: Division of HIV/AIDS Prevention: 2011 through 2015. 2011. http://www.cdc.gov/hiv/pdf/policies_DHAP-strategic-plan.pdf.
- 17.Centers for Disease Control and Prevention. FY 2013 Full Year CR Operating Plan. http://www.cdc.gov/fmo/topic/Budget Information/appropriations_budget_form_pdf/FY2013_CDC_Full-Year_CR_Operating_Plan.pdf.
- 18.Health Omnibus Program Extensions of 1988 Act. http://history.nih.gov/research/downloads/PL100-607.pdf.
- 19.Barr S. Needle-exchange programs face new federal funding ban. Kaiser health news. 2011 Dec 21. http://www.kaiserhealthnews.org/stories/2011/December/21/needle-exchange-federal-funding.aspx.
- 20.Des Jarlais DC, Guardino V, Arasteh K, Mcknight C, Milliken J, Purchase D. Current state of syringe exchange in the known universe. 2010. Presentation at the National Syringe exchange Conference; 2010 Nov 17.Google Scholar
- 21.Tempalski B, Cooper HLF, Friedman SR, Des Jarlais DC, Brady JE, Gostnell K. Correlates of syringe coverage for heroin injection in 35 large metropolitan areas in the US in which heroin is the dominant injected drug. Int J Drug Policy. 2008;19(Suppl 1):S47–58.PubMedCrossRefPubMedCentralGoogle Scholar
- 23.Office of Applied Studies SA and MHSA. Injection drug use and related risk behaviors. The NSDUH Report. 2009 Oct 29. http://www.samhsa.gov/data/2k9/139/139IDU.htm.
- 25.Kahn JG. Are NEPs cost-effective in preventing HIV infection? In: Lurie P, Reingold AL, Bowser B, Chen D, Foley J, Guydish J, et al., editors. The public health impact of needle exchange programs in the United States and abroad. San Francisco: University of California; 1993. p. 477–511.Google Scholar
- 26.Kaplan EH, Brandeau ML. AIDS policy modeling by example. AIDS. 1994;8(Suppl 1):S333–40.Google Scholar
- 31.Poulin C, Alary M, Bernier F, Carbonneau D, Boily M-C, Joly JR. Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among at-risk women, young sex workers, and street youth attending community organizations in Quebec City, Canada. Sex Transm Dis. 2001;28:437–43.PubMedCrossRefGoogle Scholar
- 34.Friedman SR, Tempalski B, Cooper HLF, Perlis TE, Keem M, Friedman R, et al. Estimating numbers of injecting drug users in metropolitan areas for structural analyses of community vulnerability and for assessing relative degrees of service provision for injecting drug users. J Urban Health. 2004;81:377–400.PubMedCrossRefPubMedCentralGoogle Scholar
- 35.Brady JE, Friedman SR, Cooper HLF, Flom PL, Tempalski B, Gostnell K. Estimating the prevalence of injection drug users in the U.S. and in large U.S. metropolitan areas from to 2002. J Urban Health. 1992;2008(85):323–51.Google Scholar
- 36.Lansky A, Finlayson T, Johnson C, Holtzman D, Wejnert C, Mitsch A, et al. Estimating the number of injection drug users in the United States to calculate National Rates of HIV Infection. 2012. Poster presentation at the 2012 National Summit on HIV Diagnosis, Prevention and Access to Care. http://www.hivforum.org/storage/hivforum/documents/_2012NationalSummit_Posting/c_115_lansky.pdf.
- 45.Vickerman P, Miners A, Williams J. Assessing the cost-effectiveness of interventions linked to needle and syringe programmes for injecting drug users: an economic modelling report Authors. 2008. http://www.nice.org.uk/nicemedia/pdf/NSPEconomicmodellingFullreportJune08.pdf. Retrieved 2012 Apr 3.
- 46.Bobashev GV, Zule WA, Morris RJ. Projecting sexual and injecting risks into future HIV outcomes with agent-based modeling. 2010. Poster presentation at the International AIDS Conference in Vienna, Austria, 2010. http://www.rti.org/pubs/bobashev_aids2010_poster.pdf.
- 47.National Research Council. Public financing and delivery of HIV/AIDS Care: securing the legacy of Ryan White. Washington, DC: The National Academies Press; 2005. http://www.iom.edu/Reports/2004/Public-Financing-and-Delivery-of-HIVAIDS-Care-Securing-the-Legacy-of-Ryan-White.aspx.