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

Sung Kim,Jolene Skordis-Worrall,Anni-Maria Pulkki-Brannstrom

doi:10.1186/1478-7547-12-25

Abstract

BackgroundHarm 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.MethodsA 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.ResultsThe 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.ConclusionsDespite 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.

Highlights

Harm reduction strategies commonly include needle and syringe programmes (NSP), opioid substitution therapy (OST) and interventions combining these two strategies
The concurrent epidemics of human immunodeficiency virus (HIV) and injecting drug use have rapidly increased HIV prevalence [2], with 10% of HIV/Acquired Immunodeficiency Syndrome (AIDS) cases worldwide attributed to injecting drug users (IDUs) [3,4]
Ukraine’s HIV prevalence is the highest in Europe and a 2010 study found that 50% of IDUs in Ukraine were HIV positive [6]

Summary

Introduction

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. There are an estimated 15.9 million injecting drug users (IDUs) worldwide, 80% of whom live in developing and transitional countries [1]. HIV prevalence in Eastern Europe and Central Asia has almost tripled since 2000 [1], to an estimated 1.4 million people in 2011 [5]. The Global Fund has spent approximately $20 m on harm reduction in the Ukraine [7]

Objectives

Methods

Results