Comparing the cost effectiveness of harm reduction strategies: a case study of the Ukraine

Cost Effectiveness and Resource Allocation

Jolene Skordis-Worrall¹  Anni-Maria Pulkki-Brannstrom³  Sung Wook Kim² 

[1]London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

[2]UCL Institute for Global Health, 30 Guilford Street, London WC1N 1EH, UK

[3]Epidemiology and Global Health Department, Umeå University, Umea, Sweden

关键词: Global Fund;    Markov Monte Carlo simulation;    Ukraine;    Opioid substitution therapy;    Needle and syringe programme;    Cost effectiveness analysis;    Harm reduction;   

Others  :  1109970
DOI  :  10.1186/1478-7547-12-25

 received in 2014-06-16, accepted in 2014-11-17,  发布年份 2014

【 摘 要 】

Background

Harm reduction strategies commonly include needle and syringe programmes (NSP), opioid substitution therapy (OST) and interventions combining these two strategies. Despite the proven effectiveness of harm-reduction strategies in reducing human immunodeficiency virus (HIV) infection among injecting drug users (IDUs), no study has compared the cost-effectiveness of these interventions, nor the incremental cost effectiveness of combined therapy. Using data from the Global Fund, this study compares the cost-effectiveness of harm reduction strategies in Eastern Europe and Central Asia, using the Ukraine as a case study.

Methods

A Markov Monte Carlo simulation is carried out using parameters from the literature and cost data from the Global Fund. Effectiveness is presented as both QALYs and infections averted. Costs are measured in 2011 US dollars.

Results

The Markov Monte Carlo simulation estimates the cost-effectiveness ratio per infection averted as $487.4 [95% CI: 488.47-486.35] in NSP and $1145.9 [95% CI: 1143.39-1148.43] in OST. Combined intervention is more costly but more effective than the alternative strategies with a cost effectiveness ratio of $851.6[95% CI: 849.82-853.55].

The ICER of the combined strategy is $1086.9/QALY [95% CI: 1077.76:1096.24] compared with NSP, and $461.0/infection averted [95% CI: 452.98:469.04] compared with OST. These results are consistent with previous studies.

Conclusions

Despite the inherent limitations of retrospective data, this study provides evidence that harm-reduction interventions are a cost-effective way to reduce HIV prevalence. More research on into cost effectiveness in different settings, and the availability of fiscal space for government uptake of programmes, is required.

【 授权许可】

   
2014 Kim et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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