Return on investment 2: evaluating the cost-effectiveness of needle and syringe programs in Australia 2009

Analysis of current NSP provision compared to no government funded NSPs (2000-2009)

Page last updated: 2009

During the period 2000-2009, gross funding for NSP services was $243m with healthcare costs saved of $1.28 billion ($1.12bn-$1.45bn, IQR) compared to no program and more than 140,000 DALYs gained. The net financial cost-saving was $1.03 billion ($876m-$1.98bn, IQR) undiscounted (see Table 8). NSP activities were cost-saving so the incremental costeffectiveness ratios were not calculated.

The net present value allows a funder to assess an investment in an intervention from the perspective of the start of a time period, as if a decision was being made at a point in time (i.e. year 2000 about funding of NSPs for the period 2000-2009). Costs are valued to a specific year (2008) and then costs and outcomes are discounted from the time of the start of the intervention (see economic methods section) at 3% or 5%. The net present value at year 2000 of $190m spent on NSPs over the period 2000-2009 (in year 2008 prices) was $896m (discounted at 3%) and $817m for $172m spent (discounted at 5%). In other words, for one dollar invested in NSPs, more than four dollars would be returned in healthcare cost-savings in addition to the investment.

The net monetary benefit of the intervention can be calculated in economic analyses: if one assumes that a government would be willing to pay $50,000 per DALY gained through healthcare interventions, then the net monetary benefit of NSPs would be more than $8 billion undiscounted and $6.2 billion discounted at 3%.

The majority of the gain was related to the prevention of HCV disease. If the benefits of prevention of HCV disease were not included, the net cost of providing NSPs was $94.8m over ten years, with a gain of 4,034 Disability-Adjusted Life Years. NSP funding was cost-effective for HIV alone in the time period, costing $4,500 per DALY gained.

Table 8: Net cost of program and gains in DALYs (undiscounted) as well as net present value (discounted (3%) and undiscounted)

Costs saved $m (IQR)
DALY gain (median)NPV current program $m (IQR) (undisc.)NPV current program $m (IQR) (3% disc.)
2000
66 (57-75)
4,087
46 (37-55)
46 (37-55)
2001
192 (171-212)
10,825
171 (149-191)
166 (145-185)
2002
137 (119-157)
12,863
116 (98-136)
109 (92-128)
2003
98 (84-107)
12,799
75 (61-84)
69 (56-77)
2004
96 (86-105)
13,089
71 (61-80)
63 (54-79)
2005
106 (94-116)
13,705
82 (70-93)
70 (60-80)
2006
119 (107-135)
15,148
93 (80-108)
78 (67-90)
2007
134 (119-154)
16,922
107 (92-127)
87 (74-103)
2008
153 (134-177)
19,301
126 (107-150)
99 (84-118)
2009
176 (148-206)
22,386
145 (118-174)
110 (90-132)
Sum
1.03bn (873m-1.98bn)
896m (758m-1.04bn)
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