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Keywords:

  • Cost-effectiveness;
  • HIV transmission;
  • injection drug use;
  • mathematical model;
  • supervised injection facility;
  • syringe exchange

ABSTRACT

Objective  To determine whether Vancouver's Insite supervised injection facility and syringe exchange programs are cost-saving—that is, are the savings due to averted HIV-related medical care costs sufficient to offset Insite's operating costs?

Methods  The analyses examined the impact of Insite's programs for a single year. Mathematical models were used to calculate the number of additional HIV infections that would be expected if Insite were closed. The life-time HIV-related medical costs associated with these additional infections were compared to the annual operating costs of the Insite facility.

Results  If Insite were closed, the annual number of incident HIV infections among Vancouver IDU would be expected to increase from 179.3 to 262.8. These 83.5 preventable infections are associated with $17.6 million (Canadian) in life-time HIV-related medical care costs, greatly exceeding Insite's operating costs, which are approximately $3 million per year.

Conclusions  Insite's safe injection facility and syringe exchange program substantially reduce the incidence of HIV infection within Vancouver's IDU community. The associated savings in averted HIV-related medical care costs are more than sufficient to offset Insite's operating costs.