COST AND COST-EFFECTIVENESS OF INCREASING ACCESS TO STERILE SYRINGES AND NEEDLES AS AN HIV PREVENTION INTERVENTION IN THE UNITED-STATES

We determined the cost of increasing access of injection drug users (I DUs) to sterile syringes and needles as an HIV prevention intervention in the United States and the cost per HN infection averted by such a program. We considered a hypothetical cohort of 1 million active IDUs in the United States. Standard methods were used to estimate the cost and cost-effectiveness of policies to increase access to sterile syrin ges and syringe disposal at various levels of coverage (e.g., a 100% c overage level would ensure access to a sterile syringe for each inject ion given current levels of illicit drug injection in the United State s; a 50% coverage level would ensure access to one half of the require d syringes). A mathematical model of HIV transmission was employed to link programmatic coverage levels with estimates of numbers of HIV inf ections averted. A policy of funding syringe exchange programs, pharma cy sales, and syringe disposal to cover all illicit drug injections wo uld cost just over $423 million U.S. for 1 year. One third of these co sts would be paid for as out-of-pocket expenditures by IDUs purchasing syringes in pharmacies. Compared with the status quo, this policy wou ld cost an estimated $34,278 U.S. per HN infection averted, a figure w ell under the estimated lifetime costs of medical care for a person wi th HIV infection. At very high levels of coverage (>88%), the marginal cost-effectiveness of increased program coverage becomes less favorab le. Although the total costs of funding large-scale IDU access to ster ile syringes and disposal seem high, the economic benefits are substan tial. Even at high levels of coverage, such funding would save society money. As part of a comprehensive program of HIV prevention, policies to increase IDUs access to sterile syringes urgently need further con sideration by public health decision makers.