AIMS: To assess the cost-effectiveness of the CARE-SHAKTI harm reduction intervention for injecting drug users (IDUs) over a 3-year period, the impact on the cost-effectiveness of stopping after 3 years and how the cost-effectiveness might vary with baseline human immunodeficiency virus (HIV) prevalence. DESIGN: Economic cost data were collected from the study site and combined with impact estimates derived from a dynamic mathematical model. SETTING: Dhaka, Bangladesh, where the HIV prevalence has remained low despite high-risk sexual and injecting behaviours, and growing HIV epidemics in neighbouring countries. FINDINGS: The cost per HIV infection prevented over the first 3 years was USD 110.4 (33.1-182.3). The incremental cost-effectiveness of continuing the intervention for a further year, relative to stopping at the end of year 3, is USD 97 if behaviour returns to pre-intervention patterns. When baseline IDU HIV prevalence is increased to 40%, the number of HIV infections averted is halved for the 3-year period and the cost per HIV infection prevented doubles to USD 228. CONCLUSIONS: The analysis confirms that harm reduction activities are cost-effective. Early intervention is more cost-effective than delaying activities, although this should not preclude later intervention. Starting harm reduction activities when IDU HIV prevalence reaches as high as 40% is still cost-effective. Continuing harm reduction activities once a project has matured is vital to sustaining its impact and cost-effectiveness.
AIMS: To assess the cost-effectiveness of the CARE-SHAKTI harm reduction intervention for injecting drug users (IDUs) over a 3-year period, the impact on the cost-effectiveness of stopping after 3 years and how the cost-effectiveness might vary with baseline human immunodeficiency virus (HIV) prevalence. DESIGN: Economic cost data were collected from the study site and combined with impact estimates derived from a dynamic mathematical model. SETTING: Dhaka, Bangladesh, where the HIV prevalence has remained low despite high-risk sexual and injecting behaviours, and growing HIV epidemics in neighbouring countries. FINDINGS: The cost per HIV infection prevented over the first 3 years was USD 110.4 (33.1-182.3). The incremental cost-effectiveness of continuing the intervention for a further year, relative to stopping at the end of year 3, is USD 97 if behaviour returns to pre-intervention patterns. When baseline IDU HIV prevalence is increased to 40%, the number of HIV infections averted is halved for the 3-year period and the cost per HIV infection prevented doubles to USD 228. CONCLUSIONS: The analysis confirms that harm reduction activities are cost-effective. Early intervention is more cost-effective than delaying activities, although this should not preclude later intervention. Starting harm reduction activities when IDU HIV prevalence reaches as high as 40% is still cost-effective. Continuing harm reduction activities once a project has matured is vital to sustaining its impact and cost-effectiveness.
Authors: Mariana Siapka; Michelle Remme; Carol Dayo Obure; Claudia B Maier; Karl L Dehne; Anna Vassall Journal: Bull World Health Organ Date: 2014-04-01 Impact factor: 9.408
Authors: Quang Duy Pham; David P Wilson; Cliff C Kerr; Andrew J Shattock; Hoa Mai Do; Anh Thuy Duong; Long Thanh Nguyen; Lei Zhang Journal: PLoS One Date: 2015-07-21 Impact factor: 3.240
Authors: Andrew P Craig; Hla-Hla Thein; Lei Zhang; Richard T Gray; Klara Henderson; David Wilson; Marelize Gorgens; David P Wilson Journal: J Int AIDS Soc Date: 2014-02-25 Impact factor: 5.396
Authors: Javier A Cepeda; Jose Luis Burgos; James G Kahn; Rosario Padilla; Pedro Emilio Meza Martinez; Luis Alberto Segovia; Tommi Gaines; Daniela Abramovitz; Gudelia Rangel; Carlos Magis-Rodriguez; Peter Vickerman; Steffanie A Strathdee; Natasha K Martin Journal: BMJ Open Date: 2019-01-29 Impact factor: 2.692