Cost-Effectiveness of Needle and Syringe Exchange for the Prevention of HIV in New York City

Shared needle and syringe use among injection drug users continues to be a major mode of transmission of HIV. Needle and syringe exchange (NSE) may be a viable strategy to reduce the transmission of the virus; yet the difficulty in measuring the actual efficacy of NSE has limited attempts to evaluate the cost-effectiveness of the intervention. Using data specific to the Lower East Side Harm Reduction Center in New York City, we assessed the cost-effectiveness of NSE over a range of conservative estimates of efficacy, obtained from both longitudinal and small-area studies. A decision-analysis model was created to compare the outcomes and costs associated with NSE. Model inputs included the cost of living with HIV and the seroprevalence of HIV among injection drug users in New York City. This analysis was conducted from both the government and societalperspectives. Tested over a range of conservative parameter estimates, NSE appears to save money and lives. The NSE program we evaluated cost $ 502 per client and produced a gain of 0.01 quality adjusted life years per client. It also reduced HIV treatment costs by $ 325,000 per case of HIV averted, and averted 4-7 HIV infections per 1000 clients, producing a net cost savings.