A cost-benefit/cost-effectiveness analysis of an unsanctioned supervised smoking facility in the Downtown Eastside of Vancouver, Canada.

Ehsan Jozaghi

doi:10.1186/1477-7517-11-30

Abstract

BackgroundSmoking crack involves the risk of transmitting diseases such as HIV and hepatitis C (HCV). The current study determines whether the formerly unsanctioned supervised smoking facility (SSF)—operated by the grassroot organization, Vancouver Area Network of Drug Users (VANDU) for the last few years—costs less than the costs incurred for health-care services as a direct consequence of not having such a program in Vancouver, Canada.MethodsThe data pertaining to the attendance at the SSF was gathered in 2012–2013 by VANDU. By relying on this data, a mathematical model was employed to estimate the number of HCV infections prevented by the former facility in Vancouver’s Downtown Eastside (DTES).ResultsThe DTES SSF’s benefit-cost ratio was conservatively estimated at 12.1:1 due to its low operating cost. The study used 70% and 90% initial pipe-sharing rates for sensitivity analysis. At 80% sharing rate, the marginal HCV cases prevented were determined to be 55 cases. Moreover, at 80% sharing rate, the marginal cost-effectiveness ratio ranges from $1,705 to $97,203. The results from both the baseline and sensitivity analysis demonstrated that the establishment of the SSF by VANDU on average had annually saved CAD$1.8 million dollars in taxpayer’s money.ConclusionsFunding SSFs in Vancouver is an efficient and effective use of financial resources in the public health domain; therefore, Vancouver Coastal Health should actively participate in their establishment in order to reduce HCV and other blood-borne infections such as HIV within the non-injecting drug users.

Highlights

Smoking crack involves the risk of transmitting diseases such as human immunodeficiency virus (HIV) and hepatitis C (HCV)
Research conducted upon a cohort of crack-user population in Vancouver’s Downtown Eastside (DTES) revealed that participants had reported 80% sharing rate as it is related to their drug smoking paraphernalia [16,17]
Some researchers have suggested that non-injecting drug users (NIDUs) are often involved in unsafe sexual behavior [18] and that hepatitis C virus (HCV) transmission in NIDUs is associated with tattooing [19]

Summary

Introduction

Smoking crack involves the risk of transmitting diseases such as HIV and hepatitis C (HCV). In British Columbia, the daily usage of crack cocaine within the general population is higher than that in any other provinces within Canada [5] This is a pressing problem in Vancouver, where daily crack use, within a cohort of injection drug users, increased from 7.4% in 1996 to 42.6% in 2005 [6]. Research conducted upon a cohort of crack-user population in Vancouver’s DTES revealed that participants had reported 80% sharing rate as it is related to their drug smoking paraphernalia [16,17]. Studies have shown a higher-than-average prevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and tuberculosis in users of crack cocaine who report no injection drug use [17]. Some researchers have stirred up a controversy in suggesting that NIDUs are essentially injecting drug users (IDUs) who have failed to report their route of transmission accurately [20]

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Results

Conclusion