This article is more than 5 years old. Information may no longer be current.

Supervised injection facilities cost-effective in Toronto, Ottawa

Establishing multiple legally sanctioned facilities for supervised illicit drug injection would be cost-effective in Toronto and Ottawa, Canada, and may lower the risk for HIV and hepatitis C virus infection transmission, according to published findings in Addiction.

“Using $50,000 per quality-adjusted life-year gained threshold for cost-effectiveness, it is likely to be cost-effective to establish at least three legally sanctioned spaces for supervised injection of illicitly obtained drugs in Toronto and two in Ottawa, Canada,” the researchers wrote in the study.

Using the Ontario health system, the annual Canadian discount rate of 5% and quality-adjusted life-years (QALYs) over a period of 20 years, Ahmed Bayoumi, MD, MSc, physician at St. Michael's Hospital, Toronto, and the University of Toronto, and colleagues, including Eva A. Enns, PhD, University of Minnesota School of Public Health, sought to determine the optimal number and cost-effectiveness of facilities in Toronto and Ottawa. They created a compartmental model of HIV and HCV that split the study participants (aged 15 to 64 years) into compartments based on sexual behavior, drug use and HIV and hepatitis C infection and used published literature, a drug use survey from 2006 and health records as model parameters.

Ahmed Bayoumi, MD, MSc 

Results showed that in Toronto, one facility cost $4.1 million and led to a gain of 385 QALYs over 20 years. This resulted in an incremental cost effectiveness ratio (ICER) of $10,763 per QALY and cost savings up to $278,311. One facility in Ottawa had an ICER of $6,127 per QALY and a cost savings up to $179,272.

Multiple sensitivity analyses showed that, using a threshold of $50,000 per QALY, three facilities would be more cost-effective in Toronto and two in Ottawa compared with just one in each city. In Toronto, the probability of three facilities being cost-effective was 17%, four facilities was 21% and five facilities was 41%. In Ottawa, the probability of three facilities being cost-effective was 13%, four facilities was 35% and five facilities was 41%.

Zero facilities in Toronto had a 14% unlikelihood of being the most cost-effective option compared with Ottawa (10%). There was an 86% chance that one or more supervised injection facilities would be cost-effective in Toronto and a 90% chance in Ottawa, according to the press release.

“Our sensitivity analyses suggest that the total number of people who inject drugs, the number of people who use a facility, the decrease in needle sharing among people who use a facility and facility operating costs are also important parameters to estimate accurately,” the researchers wrote.

The researchers concluded: “In both cities, results were robust if the reduction in needle sharing among clients of the facilities was at least 50% and fixed operating costs were less than $2 million.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.