Comparing the cost effectiveness of harm reduction strategies: a case study of the Ukraine
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RESEARCH
Open Access
Comparing the cost effectiveness of harm reduction strategies: a case study of the Ukraine Sung Wook Kim1*, Anni-Maria Pulkki-Brannstrom1,2 and Jolene Skordis-Worrall1,3
Abstract Background: 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. Methods: A 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. Results: The 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. Conclusions: Despite 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. Keywords: Harm reduction, Cost effectiveness analysis, Needle and syringe programme, Opioid substitution therapy, Ukraine, Markov Monte Carlo simulation, Global Fund
Background There are an estimated 15.9 million injecting drug users (IDUs) worldwide, 80% of whom live in developing and transitional countries [1]. The concurrent epidemics of HIV and injecting drug use have rapidly increased HIV prevalence [2], with 10% of HIV/Acquired Immunodeficiency Syndrome (AIDS) cases worldwide attributed to IDUs [3,4]. 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 region is also home to 3.7 million IDUs [1]. Ukraine’s HIV prevalence is the highest in Europe and a 2010 study found that 50% of IDUs in Ukraine were HIV positive [6]. The Global Fund has spent approximately $20 m on harm reduction in the Ukraine [7]. * Correspondence: [email protected] 1 UCL Institute for Global Health, 30 Guilford Street, London WC1N 1EH, UK Full list of author information is available at the end of the article
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