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Supervised injection for PWID potentially cost-effective
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Opening a supervised injection facility for people who inject drugs, or PWID, could generate $3.5 million in savings in San Francisco, according to a cost-benefit analysis published in the Journal of Drug Issues.
“Supervised injection facilities have been shown to improve the health and safety of both the people who use them and the surrounding neighborhoods,” Alex Kral, PhD, director of the behavioral and urban health program at RTI International, said in a press release. “Our study looked specifically at San Francisco, where there’s a large opioid problem, and assessed whether opening a safe injection facility would result in a net benefit to society.”
Saving lives, saving money
According to HHS, the opioid epidemic costs the U.S. $75 billion annually. Although less than 1% of the U.S. population injects drugs, these PWID experience about 56% of new HCV infections, 11% of new HIV infections, and over 30% suffer from skin and soft tissue infections (SSTIs), the press release said.
The investigators determined that a single supervised injection facility in San Francisco would prevent 3.3 cases of HIV and 19 cases of HCV each year, reduce hospital stays for SSTIs by 415 days each year, save 0.24 lives each year on average, and enable 110 people to enter medication-assisted treatment.
“While the predicted results may sound small, they are substantial for a single facility,” Kral said in the release. “Three HIV infections is roughly 6% of the city’s total annual injection-related HIV infections, and we estimate that 19 HIV infections comprises roughly 3% to 5% of the city’s total annual injection-related HCV infections.”
Kral and colleagues discovered that the associated outcomes of a supervised injection facility would produce approximately $6.1 million in health savings annually. With an estimated cost of operating the facility at $2.6 million, net savings would $3.5 million each year.
“Our analysis shows that a supervised injection facility will not only help keep San Franciscans who inject drugs alive and out of the hospital, but it will encourage them to seek help and save taxpayer money,” Amos Irwin, study researcher and chief of staff at the Criminal Justice Policy Foundation, said in the release.
More facilities increase cost-effectiveness
A previous study from Canada showed that establishing at least three legally sanctioned spaces for supervised injection of illicit drugs would be cost-effective, and could lower the risk for HIV and HCV transmission.
Eva A. Enns, PhD, from the University of Minnesota School of Public Health, and colleagues compared facilities in Toronto and Ottawa, Canada, to determine cost-effectiveness and the optimal number of facilities. They found that three facilities would be more profitable in Toronto and two in Ottawa compared with only one facility in each city using a threshold of $50,000 per quality-adjusted life-years as a measure of cost-effectiveness.
Compared with the one facility in San Francisco, which would generate $2.33 in U.S. savings for every $1 spent, Enns and colleagues saw in both Canadian cities the probability of cost-effectiveness increasing with number of facilities. They estimated cost-effectiveness of three facilities at 17%, four at 21% and five at 41% in Toronto. In Ottawa, the probability of cost-effectiveness of three facilities was 13%, four was 35% and five was 41%. In Toronto, there was an 86% probability that one or more supervised injection facilities would be cost-effective, and a 90% probability in Ottawa.
There are currently no supervised injection facilities in the U.S. However, nearly 100 of these facilities exist across 11 countries to provide secure, clean spaces and equipment for people to safely inject drugs with medical staff nearby, according to the release. – by Savannah Demko
Disclosure: The researchers report no relevant financial disclosures.
References:
Enns EA, et al. Addiction. 2015;doi:10.1111/add.13195.
Irwin A, et al. J Drug Issues. 2016;doi:10.1177/0022042616679829.
U.S. Department of Health and Human Services. The Opioid Epidemic: By the Numbers. https://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf. Accessed December 27, 2016.
Perspective
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Peter Chin-Hong, MD, MAS
Although there are limitations to the assumptions that go into their cost-effectiveness model, Irwin and colleagues demonstrate that even a conservative approach shows substantial savings by establishing a supervised injection facility in San Francisco. But San Francisco is a special place. There have been great strides in recent years to reduce new HIV infections, so there would be a more modest impact in this dimension. Expanding access to early HIV treatment (“Getting to Zero” campaign) has reduced community HIV viral load, thereby reducing the chances of HIV transmissibility. Specific interventions in people who inject drugs in San Francisco already include widespread access to naloxone to prevent overdoses and deaths, dedicated integrated clinics to treat skin infections, as well as mobile health services and needle exchange. In communities where coordinated health services are less robust, the savings would likely be even more dramatic. The most intangible benefit is arguably the hardest to include in a model — the psychological relief as deaths are averted and productive years of life lost are restored to society.
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