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
The authors acknowledge the valuable data from the annual surveys of NSPs which Beth Israel Medical Center and North American Syringe Exchange Network conduct with support from amFAR/The Foundation for AIDS Research using funding from the Elton John Foundation and the Irene Diamond-Tides Foundation. Trang Q. Nguyen acknowledges the funding from the Sommer Scholars Program, and Brian W. Weir acknowledges the funding from the National Institute on Drug Abuse (Grant F31 DA026763), for their doctoral training.
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