The cost-effectiveness of needle-syringe exchange programs in Eastern Europe and Central Asia: Costing, data synthesis, modeling and economics for eight case study countries

D. Wilson, L. Zhang, C. Kerr, A. Kwon, A. Hoare , M. Williams-Sherlock, C. Avila, EECA NSEP evaluation working group

Research output: Contribution to conferenceAbstract


Background: To evaluate the impact and cost-effectiveness of needle-syringe exchange programs (NSEPs) in Eastern Europe and Central Asia (EECA) in preventing HIV and hepatitis C virus (HCV) infections among injecting drug users (IDUs).

Methods: A data triangulation process was conducted across eight countries in EECA. This informed a health economic analysis incorporating a mathematical model of HIV and HCV transmission and disease progression among IDUs. We compared the epidemiological outcomes and costs of NSEP coverage with scenarios of no NSEPs, with counterfactual receptive sharing determined based on an empirical relationship of associations with syringe availability in each country. Outcomes included numbers of HIV and HCV infections averted, lifetime healthcare costs from a health sector perspective, and cost per QALY gained. Discounting was applied at 0% and 3%.

Results: There were substantially increased financial investments in NSEPs over 2005–2010. The average number of needle-syringes distributed, and proportion of IDUs reached, across all eight countries increased by more than 300%. For all eight countries, the reported level of receptive sharing decreased with increases in the per capita distribution of needle-syringes. NSEPs were estimated to avert 10–40% of HIV infections across the eight countries; a lower percentage of HCV infections were averted (~5–25% for six countries and slightly higher in two countries). NSEPs were found to already be cost-saving or cost-effective, with respect to HIV alone in the short-term, in four of eight countries, borderline cost-effective in two countries, but not yet cost-effective in two countries. When considering the additional health benefits of averted HCV infections, or the lifetime benefits of HIV infections averted, NSEPs were very cost-effective to cost-saving in all countries.

Conclusion: There is strong evidence that NSEPs have been effective in reducing risk, leading to reduced HIV and HCV infections averted, and are a very cost-effective public health strategy in EECA.
Original languageEnglish
Number of pages2
Publication statusPublished - 22 Oct 2012
Externally publishedYes
EventInternational AIDS Conference 2012 - Walter E. Washington Convention Center, Washington, United States of America
Duration: 22 Jul 201227 Jul 2012
Conference number: 19


ConferenceInternational AIDS Conference 2012
Country/TerritoryUnited States of America

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