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.”

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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.