1.1 Background
1.2 Methodology
1.3 Acknowledgement

1.1 Background

In 2000, the Department of Health and Ageing engaged Health Outcomes International Pty Ltd (HOI) in association with the National Centre for HIV Epidemiology and Clinical Research (NCHECR) to undertake a study into the economic effectiveness (or financial return on investment) of needle and syringe programs (NSPs) in Australia.

The study updates and expands a study previously undertaken by Hurley, Jolley and Kaldor which investigated the effectiveness and cost effectiveness of needle and syringe programs in relation to HIV/AIDS (see 'The effectiveness and cost-effectiveness of needle and syringe exchange programs' in An Economic Evaluation of Aspects of the Australian HIV/AIDS Strategies, Technical Appendix 2 to Valuing the past...investing in the future - Evaluation of the National HIV/AIDS Strategy 1993-94 to 1995-96).

The study seeks to analyse the effectiveness of needle and syringe programs in preventing transmission of HIV, and hepatitis C (HCV) in Australia from 1991 (that is from when NSPs were well established in all jurisdictions except Tasmania) to the end of 2000. The study then uses these findings to calculate the return on investment from NSPs from 1991 to 2000. Specifically the aims of the study were to:
  • Estimate the effectiveness of NSPs in relation to preventing transmission of HIV as well as hepatitis B and hepatitis C;

  • Calculate the return on investment in NSPs from 1991 to the present; and

  • Provide contemporary research on the effectiveness and efficiency of the NSPs in order to assist stakeholders and governments to demonstrate the role of NSPs as a core population health activity, and to support further investment in NSPs if necessary.
For several reasons the project examined effectiveness in relation to prevention of HIV and hepatitis C, but not hepatitis B. First, epidemiological data were more readily accessible for HIV and hepatitis C, in particular in the Australian setting. Second, the vast majority (possibly greater than 95%) of injecting drug users exposed to hepatitis B do not develop chronic infection, and are therefore not at risk of major hepatitis B-related morbidity and mortality. Third, there is greater uncertainty in relation to the natural history of chronic hepatitis B. The exclusion of hepatitis B from the analysis therefore represents a conservative approach, and may underestimate, to some extent, the total costs of treatment avoided. Top of page

1.2 Methodology

The study comprised two discrete stages. The first related to the development of an agreed methodology that examined the international evidence base and data from within Australia to support the study, and from that evidence, to develop an approach that maximised the use of available data.

The second stage of the study was the implementation of the approved methodology, the outcomes of which are presented in this report. The key components of the methodology were:
  • An ecological study of the effect of NSPs on HIV and HCV, based on the international literature together with a range of related information and data from within Australia.
  • Collection of data on the costs of operating NSPs in all Australian jurisdictions.
  • Collection of data on the lifetime costs of treatment of HIV and HCV in the current clinical environment.
  • Determination of Quality of Life (QoL) values for persons with HIV and HCV.
  • Development and application of an economic model to evaluate the return on investment in NSPs.
  • Determination of the quality of life impacts of NSPs on HIV and HCV.
  • Preparation of draft and final reports presenting our findings.
In applying the findings of the impact of NSPs on HIV and HCV in Australia, we have assumed that NSPs have had no effect on the size of the injecting drug user population (i.e. that NSPs do not increase drug use). Whilst acknowledging the debate that exists on this subject, the available evidence from Australia and overseas has not demonstrated that NSPs have resulted in an increase in drug use, and hence our assumption is reasonable (See Guydish et al (1993), Watters et al (1994), Wolk et al (1990) and Schoenbaum et al (1996)).

1.3 Acknowledgement

Throughout the course of the study, a number of individuals and organisations across Australia have contributed information, data, advice and other forms of assistance to the researchers. Their contribution is gratefully acknowledged.