Low Cost Needle and Syringe Programs Reduce HCV Transmission Effectively

Needle and syringe programs are a highly effective, low-cost intervention to reduce hepatitis C virus (HCV) transmission, according to a study published in Addiction.¹

HCV is a global public health issue, with most new infections occurring in people who inject drugs.^2-5 Needle and syringe programs are the primary intervention used for reducing the transmission of blood-borne viruses among injection drug users. Although previous research has demonstrated that needle and syringe programs are a cost-effective intervention to reduce the incidence of HIV,^6-13 there are few studies evaluating the same phenomena in HCV.^7,14 

Therefore, researchers evaluated the cost-efficacy of current needle and syringe programs on the transmission and disease burden of HCV in 3 areas in the United Kingdom and compared it with a counterfactual scenario where needle and syringe programs are removed for 10 years and then returned to existing levels with effects collected for 40 years.¹

Researchers found that needle and syringe programs were highly cost-effective over a time-horizon of 50 years and that they decreased the number of HCV incident infections. More than 90% of simulations were cost-effective at the willingness-to-pay threshold and the results were robust to sensitivity analyses including varying the time-horizon, HCV treatment cost, and numbers of HCV treatments per year. In addition, the results demonstrated that a median of 84 to 199 infections, and 2 to 20 deaths in each area would be averted by continuing needle and syringe programs

“Needle and syringe programmes are a highly effective low-cost intervention to reduce hepatitis C virus transmission, and in some settings, they are cost-saving,” concluded the study authors.¹ They added that, “Needle and syringe programmes are likely to remain cost-effective irrespective of changes in hepatitis C virus treatment cost and scale-up.”

References

1. Sweeney S, Ward Z, Platt L, et al. Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing hepatitis C transmission in people who inject drugs [published online January 23, 2019]. Addiction. doi: 10.1111/add.14519.
2. Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology. 2013;57:1333-1342.
3. Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol. 2006;45:529-538.
4. Public Health England. Hepatitis C in the UK 2015 report. July 2015. Accessed February 12, 2019.
5. Public Health England. People who inject drugs: HIV and viral hepatitis unlinked anonymous monitoring survey tables (pyschoactive): 2016 update. Accessed February 12, 2019.
6. Guinness L, Vickerman P, Quayyum Z, et al. The cost-effectiveness of consistent and early intervention of harm reduction for injecting drug users in Bangladesh. Addiction. 2010;105:319-328.
7. Kwon JA, Anderson J, Kerr CC, et al. Estimating the cost-effectiveness of needle–syringe programs in Australia. AIDS. 2012;26:2201-2210.
8. Jones L, Pickering L, Sumnall H, Mcveigh J, Mark A, Bellis M. A review of the effectiveness and cost-effectiveness of needle and syringe programmes for injecting drug users. June 2008. Accessed February 12, 2019.
9. Vickerman P, Kumaranayake L, Balakireva O, et al. The cost-effectiveness of expanding harm reduction activities for injecting drug users in Odessa, Ukraine. Sex Transmit Dis. 2006;33:S89-S102.
10. Kumaranayake L, Vickerman P, Walker D, et al. The cost-effectiveness of HIV preventive measures among injecting drug users in Svetlogorsk, Belarus. Addiction. 2004;99:1565-1576.
11. Kaplan EH. Economic analysis of needle exchange. AIDS. 1995;9:1113-1120.
12. Laufer FN. Cost-effectiveness of syringe exchange as an HIV prevention strategy. J Acquir Immune Defic Syndr. 2001;28:273-278.
13. 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;90:168-171.
14. Pollack HA. Cost-effectiveness of harm reduction in preventing hepatitis C among injection drug users. Med Decis Making. 2001;21:357-367.