Needle-Exchange Programs Cost-Effective Way to Reduce Hepatitis C Among Drug Users: Public Health Watch

US Surgeon General Jerome M. Adams, MD, raised a few eyebrows last year when he indicated that he supported the use of needle-exchange programs to address the issue of infectious disease outbreaks in the face of the ongoing opioid crisis.

That’s because such programs have historically been considered a political non-starter in this country, with objections from those in the “not-in-my-backyard” set, as well as those who believe that they encourage drug abuse—the latter in spite of evidence to the contrary.

Now, a new study out of the UK, which will appear in the March issue of the journal Addiction, suggests that needle-exchange may be the most cost-effective way to prevent and/or control hepatitis C outbreaks associated with injection drug use. Several outbreaks of hepatitis C, as well as HIV, in the United States have been linked with illegal opioid use, as Contagion® has reported recently.

The study investigators, from the University of Bristol and the London School of Hygiene & Tropical Medicine, indicate that, perhaps not surprisingly, Britain is experiencing similar problems. They cite data from Public Health England, which estimates that of the 200,000 people living with hepatitis C in the country, some 90% acquired their infections via injection drug use.

In research funded by the UK’s National Institute for Health Research, the authors of the Addiction paper used data from 3 cities—Bristol, where some 45% of injection drug users have been diagnosed with hepatitis C; Dundee (26%), and Walsall (18%)—to estimate the costs associated with existing needle and syringe programs in each.

The investigators used mathematical models to estimate the impact of these programs on the spread of hepatitis C in each community as a means of assessing their cost-effectiveness. This latter analysis included projections on hepatitis C transmission in each city should their respective needle-exchange programs be discontinued for the first 10 years of a 50-year time period (2016-2065).

Notably, for all 3 cities, needle-exchange programs resulted in reduced total health care costs when compared with cost estimates if these programs were discontinued. In fact, total health care costs were reduced by as much as £2.5 million ($3.3 million USD) (in Dundee).

In addition, the investigators found that the exchange programs would reduce hepatitis C infections in all 3 cities—by 8% in Bristol and Walsall and 40% in Dundee—between 2016 and 2065. Finally, there were also significant gains in quality adjusted life years (QALYs) for injection drug users in these cities (502 in Bristol, 195 in Dundee, and 192 in Walsall).

And, in a related study from the same project, the investigators found that opioid substitution therapy (eg, methadone) reduced the risk of hepatitis C transmission among people who inject drugs by as much as 50%, while combining opioid substitution therapy with high-coverage needle-exchange (providing at least 1 sterile needle for each injection) cut the risk for transmission by 74%.

In a statement released with the study, co-author Sedona Sweeney, a research fellow at the London School of Hygiene & Tropical Medicine, noted that, “Our results very clearly indicate that needle and syringe programs are likely to be a strong investment choice—not only in the UK but also other parts of the world where there are similar levels of hepatitis C infection among people who inject drugs. It is imperative that countries follow the recommendations of the World Health Organization by scaling up provision of needle and syringe programs and opioid substitution therapy. Our findings provide important new evidence to demonstrate that not only could this lead to fewer people being infected with this potentially life-changing virus, but could also save money for other local services, which means better health and social care for everyone.”

Which is the idea, right?