London School of Hygiene & Tropical Medicine

Providing clean injecting equipment through needle and syringe programmes is a highly cost-effective way of preventing hepatitis C (HCV) transmission among people who inject drugs and could save millions of pounds in infection treatment costs in the UK, according to new research published in Addiction. 

The study, led by Lucy Platt at the London School of Hygiene & Tropical Medicine (LSHTM) and the University of Bristol, is the first to evaluate the cost-effectiveness of needle and syringe programmes in Western Europe.

Hepatitis C is a blood-borne virus that can seriously damage the liver and cause death if left untreated. Over 200,000 people are infected with HCV in the UK and over 90% of new infections are acquired through injecting drugs. Needle and syringe programmes provide sterile injecting equipment and other prevention and support services. In the UK, they are delivered through pharmacies, mobile vans and specialist agencies.

Using data from three cities with different levels of HCV infection among people who inject drugs – Bristol (45%), Dundee (26%) and Walsall (18%) - the researchers estimated the costs of existing needle and syringe programmes in each city, used mathematical models to estimate their impact on the spread of HCV infection, then estimated the cost-effectiveness of the programmes in each city.

The team projected how the spread of HCV would increase if all needle and syringe programmes were stopped for the first 10 years of a 50-year time period (2016-2065).

In all three areas, current needle and syringe programmes resulted in lower healthcare and treatment costs compared to if the programmes were stopped. There were estimated cost-savings of £159,712 in Bristol and £2.5 million in Dundee.

There were also projected reductions in the number of HCV infections - by 8% in Bristol and Walsall and 40% in Dundee between 2016 and 2065. Improvements were also seen in the quality of life among people who inject drugs. Health gains were estimated as quality adjusted life years (QALYs), which measures the number life years saved and the quality of health during those years. NSPs were estimated to contribute 502 additional QALYs in Bristol, 195 in Dundee and 192 in Walsall.

The researchers also found that needle and syringe programmes would continue to be cost-effective if HCV treatment rates increased or treatment costs reduced, because of their effectiveness in preventing re-infection.

Sedona Sweeney who led the economic evaluation from LSHTM, said:  “Access to this type of data can be so important in helping policy makers make tough decisions about how to invest in public services. Our results very clearly indicate that needle and syringe programmes 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 programmes 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.”

Dr Zoe Ward, from the University of Bristol and co-lead author of the study, said: “We have evaluated the impact and cost-effectiveness of needle and syringe programmes in the UK for the first time.

“The results are clear. Needle and syringe programmes not only reduce the number of new HCV infections among people who inject drugs and improve their quality of life, they are also low-cost, excellent value for money and, in some areas, save money, which is good news for our cash-strapped local authorities.

“We hope that Public Health England, local government commissioners and policy makers will take note and continue to commission needle and syringe programmes, which are currently under threat of funding cuts.”

In a related study from the same project, the researchers found that opioid substitution therapy, such as methadone, halved the risk of acquiring HCV infection among people who inject drugs, and combining opioid substitution therapy with high-coverage needle and syringe provision (providing at least one sterile needle for each injection) led to a 74% reduction in risk.

The authors acknowledge the limitations of their study including gaps in some of the data collected. Pharmacy-based needle and syringe programmes included in the study did not always have detailed records available.  The study also did not account for other benefits that NSPs provide including reducing skin or soft tissue infection, preventing HIV infection and providing crucial support with mental health and social welfare. Taking these factors into account is highly  likely to increase the  cost savings produced by NSPs.

The National Institute for Health Research, Public Health Research Programme funded the study.

Publication

Sedona Sweeney, Zoe Ward, Lucy Platt, Lorna Guinness, Matthew Hickman, Vivian Hope, Lisa Maher, Jenny Iversen, Sharon J. Hutchinson, Josie Smith, Rachel Ayres, Ingrid Hainey and Peter Vickerman. Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing hepatitis C transmission in people who inject drugs. Addiction. DOI: 10.1111/add.14519