A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Montreal, Canada

Substance Abuse Treatment, Prevention, and Policy

Martin A Andresen¹  Andrew A Reid¹  Ehsan Jozaghi¹ 

[1] School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada V5A 1S6

关键词: Cost-effectiveness;    Cost-benefit;    Harm reduction;    Supervised injection facility;   

Others  :  833977
DOI  :  10.1186/1747-597X-8-25

 received in 2013-04-21, accepted in 2013-07-03,  发布年份 2013

【 摘 要 】

Background

This paper will determine whether expanding Insite (North America’s first and only supervised injection facility) to more locations in Canada such as Montreal, cost less than the health care consequences of not having such expanded programs for injection drug users.

Methods

By analyzing secondary data gathered in 2012, this paper relies on mathematical models to estimate the number of new HIV and Hepatitis C (HCV) infections prevented as a result of additional SIF locations in Montreal.

Results

With very conservative estimates, it is predicted that the addition of each supervised injection facility (up-to a maximum of three) in Montreal will on average prevent 11 cases of HIV and 65 cases of HCV each year. As a result, there is a net cost saving of CDN$0.686 million (HIV) and CDN$0.8 million (HCV) for each additional supervised injection site each year. This translates into a net average benefit-cost ratio of 1.21: 1 for both HIV and HCV.

Conclusions

Funding supervised injection facilities in Montreal appears to be an efficient and effective use of financial resources in the public health domain.

【 授权许可】

   
2013 Jozaghi et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Mathers BM, Degenhardt L, Buccello C, Lemon J, Wiessing L, Hickman M: Mortality among people who inject drugs: a systematic review and meta-analysis. Bull World Health Organ 2013, 91:102-123.
• [2]World Health Organization: HIV/AIDS: Injecting drug use. 2013. [http://www.who.int/hiv/topics/idu/en/index.html webcite]
• [3]Rehm J, Ballunas D, Brochu S, Fischer B, Gnam W, Patra J, Popova S, Sarnocinska-Hart A, Taylor B: The Costs of Substance Abuse in Canada 2002: Highlights. Ottawa, ON: Canadian Centre on Substance Abuse; 2006.
• [4]Canadian Centre on Substance Abuse: Injection Drug Users Overview. 2011. http://www.ccsa.ca/Eng/Topics/Populations/IDU/Pages/InjectionDrugUsersOverview.aspx webcite
• [5]Archibald CP, Jayaraman GC, Major C, Patrick DM, Houston SM, Sutherland D: Estimating the size of hard-to-reach populations: A novel method using HIV testing data compared to other methods. AIDS 2001, 15:S41-S48.
• [6]Roy E, Arruda N, Vaillancourt E, Boivin J, Morissette C, Leclerc P, et al.: Drug use patterns in the presence of crack in downtown Montreal. Drug Alcohol Rev 2012, 31:72-80.
• [7]Morissette C, Cox J, De P, Tremblay C, Roy E, Allard R, et al.: Minimal uptake of sterile drug preparation equipment in a predominantly cocaine injection population: Implications for HIV and hepatitis C prevention. Int J Drug Policy 2007, 18:204-212.
• [8]De P, Cox J, Boivin JF, Platt RW, Jolly AM, Alexander PE: HIV and HCV discordant injecting partners and their association to drug equipment sharing. Scand J Infect Dis 2007, 41:206-214.
• [9]Bruneau J, Daniel M, Kestens Y, Zang G, Généreux M: Association between HIV-related injection behavior and distance to and patterns of utilisation of syringe-supply programmes. J Epidemiol Community Health 2008, 62:804-810.
• [10]Jozaghi E: The science versus the politics: The need for supervised injection facilities in Montreal, Canada. Int J Drug Policy 2012, 23:420-421.
• [11]Andresen MA, Jozaghi E: The point of diminishing returns: an examination of expanding Vancouver’s Insite. Urban Studies 2012, 49(16):3531-3544.
• [12]CTVNews.ca Staff: CMA 'deeply concerned' about tighter rules for safe injection sites. 2013. http://www.ctvnews.ca/health/cma-deeply-concerned-about-tighter-rules-for-safe-injection-sites-1.1313766 webcite
• [13]O'Neil P: Vancouver's supervised injection site will survive new federal rules, supporter say. 2013. http://www.vancouversun.com/health/Vancouver+supervised+injection+site+will+survive+federal/8488985/story.html webcite
• [14]Semaan S, Fleming P, Worrell C, Stolp H, Baack B, Miller M: Potential role of safer injection facilities in reducing HIV and Hepatitis C infections and overdose mortality in the United States. Drug Alcohol Depend 2011, 118:100-110.
• [15]Bayoumi AM, Zaric GS: The cost-effectiveness of Vancouver’s supervised injection facility. Can Med Ass J 2008, 179(11):1143-1151.
• [16]Pinkerton SD: Is Vancouver Canada’s supervised injection facility cost-saving? Addiction 2010, 105:1429-1436.
• [17]Andresen MA, Boyd NT: A cost–benefit and cost-effectiveness analysis of Vancouver’s supervised injection facility. Int J Drug Policy 2010, 21:70-76.
• [18]Jacobs P, Calder P, Taylor M, Houston S, Saunders LD, Albert T: Cost effectiveness of streetworks’ needle exchange program of Edmonton. Can J Public Health 1999, 90(3):168-171.
• [19]Généreux M, Bruneau J, Daneil M: Association between neighborhood socioeconomic characteristics and high-risk injection behavior amongst injection drug users living in inner and othe city areas in Montreal, Canada. Int J Drug Policy 2010, 21:49-55.
• [20]Broadhead RS, Kerr TH, Grund JP, Altice FL: Safer injection facilities in North America: Their place in public policies and health initiatives. J Drug Issues 2002, 32:329-355.
• [21]Kaplan EH, O’Keefe E: Let the needles do the talking! Evaluating the New Haven needle exchange. Interfaces 1993, 23:7-26.
• [22]Gore SM, Bird AG: Study size and documentation to detect injection-related hepatitis C in prison. Quantitative J Med 1998, 91:353-357.
• [23]Des Jarlais DC, Arasteh K, Hagan H: Evaluating Vancouver’s supervised injection facility: Data and dollars, symbols and ethics. Can Med Assoc J 2008, 179(11):1105-1106.
• [24]Gold M, Gafni A, Nelligan P, Millson P: Needle exchange programs: An economic evaluation of a local experience. Can Med Assoc J 1997, 157(3):255-262.
• [25]Chen RY, Accortt NA, Westfall AO, Mugavero MJ, Raper JL, Cloud GA, et al.: Distribution of health care expenditure for HIV-infected patients. Clin Infect Dis 2006, 42:1003-1010.
• [26]Holtgrave DR, Pinkerton SD: Updates of cost of illness and quality of life estimates for use in economic evaluations of HIV prevention programs. J Acquir Immune Defic Syndr Hum Retrovirol 1997, 16:55-61.
• [27]Pinkerton SD, Holtgrave DR: Assessing the cost-effectiveness of HIV prevention interventions: a primer. In Handbook of Economic Evaluation of HIV Programs. Edited by Holtgrave DR. New York: Plenum; 1998:33-43.
• [28]Werb D, Wood E, Kerr T, Hershfield N, Palmer RWH, Remis RS: Treatment costs of hepatitis C infection among injection drug users in Canada, 2006–2026. Int J Drug Policy 2011, 22:70-76.
• [29]Albert T, Williams G, Legowski B, Remis R: The economic burden of HIV/AIDS in Canada. Ottawa, ON: Canadian Policy Research Networks; 1998.
• [30]Pinkerton SD: How many HIV infections are prevented by Vancouver Canada’s supervised injection facility? Int J Drug Policy 2011, 22:179-183.
• [31]Krajden M, Kuo M, Zagorski AM, Yu A, Krahn M: Health care costs associated with hepatitis C: A longitudinal cohort study. Canadian J Gastroenterol 2010, 24(12):717-726.
• [32]Martin N, Vickerman P, Miners A, Foster GR, Hutchinson SJ, Goldberg DJ, et al.: Cost-effectiveness of Hepatitis C virus antiviral treatment for injection drug user populations. Hepatology 2012, 55(1):49-57.
• [33]National Centre in HIV Epidemiology and Clinical Research: Epidemiological and economical impact of potential increased hepatitis C treatment uptake in Australia. Sydney: The University of New South Wales; 2010.
• [34]Holtgrave DR, Pinkerton SD, Jones TS, Lurie P, Vlahov D: Cost and cost-effectiveness of increasing access to sterile syringes and needles as an HIV prevention intervention in the United States. J Acquir Immune Defic Syndr Hum Retrovirol 1998, 18(Suppl 1):S133-S138.
• [35]Laufer FN: Cost-effectiveness of syringe exchange as an HIV prevention strategy. J Acquir Immune Defic Syndr 2001, 28:273-278.
• [36]McClean ME: Vancouver drug use epidemiology-2001: Vancouver and BC site report for the Canadian community epidemiology network on drug use. Vancouver, BC: Vancouver-Richmond Health Board; 2002.
• [37]Health Canada: Vancouver’s Insite service and other supervised injection sites: What has been learned from research? Final report of the export advisory committee. Ottawa (ON): Health Canada; 2008.
• [38]Canada Newswire: A slightly softer rental market in the Montreal metropolitan area. 2006. [http://search.proquest.com/docview/453170769?accountid=13800 webcite]
• [39]Nurses Union: Overview of key nursing contract provisions. 2011. http://www.nursesunions.ca/sites/default/files/2011.07.contract_comparison.e.pdf webcite
• [40]Kerr T, Tyndall M, Li K, Montaner J, Wood E: Safer injection facility use and syringe sharing in injection drug users. Lancet 2005, 366:316-318.
• [41]MSIC Evaluation Committee: Final report on the evaluation of the Sydney Medically Supervised Injection Center. Sydney (Australia): Authors; 2003.