CMAJ • November 18, 2008; 179 (11). doi:10.1503/cmaj.080808.
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
Ahmed M. Bayoumi, MD MSc and
Gregory S. Zaric, PhD
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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The cost-effectiveness of Vancouver's supervised injection facility
From the Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute (Bayoumi), St. Michael's Hospital; the Departments of Medicine and of Health Policy, Management and Evaluation (Bayoumi), University of Toronto; and The Ivey School of Business (Zaric), University of Western Ontario, London, Ont.
Correspondence to: Dr. Ahmed M. Bayoumi, Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond St., Toronto ON M5B 1W8; fax 416 864-5486; ahmed.bayoumi{at}utoronto.ca
Background: The cost-effectiveness of Canada's only supervised injection facility has not been rigorously evaluated. We estimated the impact of the facility on survival, rates of HIV and hepatitis C virus infection, referral to methadone maintenance treatment and associated costs.
Methods: We simulated the population of Vancouver, British Columbia, including injection drug users and persons infected with HIV and hepatitis C virus. The model used a time horizon of 10 years and the perspective of the health care system. We compared the situation of the supervised injection facility with one that had no facility but that had other interventions, such as needle-exchange programs. The effects considered were decreased needle sharing, increased use of safe injection practices and increased referral to methadone maintenance treatment. Outcomes included life-years gained, costs, and incremental cost-effectiveness ratios discounted at 5% per year.
Results: Focusing on the base assumption of decreased needle sharing as the only effect of the supervised injection facility, we found that the facility was associated with an incremental net savings of almost $14 million and 920 life-years gained over 10 years. When we also considered the health effect of increased use of safe injection practices, the incremental net savings increased to more than $20 million and the number of life-years gained to 1070. Further increases were estimated when we considered all 3 health benefits: the incremental net savings was more than $18 million and the number of life-years gained 1175. Results were sensitive to assumptions related to injection frequency, the risk of HIV transmission through needle sharing, the frequency of safe injection practices among users of the facility, the costs of HIV-related care and of operating the facility, and the proportion of users who inject in the facility.
Interpretation: Vancouver's supervised injection site is associated with improved health and cost savings, even with conservative estimates of efficacy.
Related Article
- Evaluating Vancouver's supervised injection facility: data and dollars, symbols and ethics
- Don C. Des Jarlais, PhD, Kamyar Arasteh, PhD, and Holly Hagan, PhD
Can. Med. Assoc. J. 2008 179: 1105-1106.[Full Text] [PDF]
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  D. C. Des Jarlais PhD, K. Arasteh PhD, and H. Hagan PhD Evaluating Vancouver's supervised injection facility: data and dollars, symbols and ethics Can. Med. Assoc. J., November 18, 2008; 179(11): 1105 - 1106. [Full Text] [PDF]
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