Needle exchange economics

One of the arguments against needle exchange is that taxpayers should not have to bear the cost of such programs. However, this argument does not take into account, the taxpayer money in emergency room medical costs that would be saved through such a program.
An analysis of these costs is presented below. But first, here is a quote from Nancy W. Dickey, MD, President-Elect of the American Medical Association, confirming that such programs really do curtail the transmission of HIV:
"The American Medical Association recognized one year ago, in a policy statement adopted by our House of Delegates, that important advances to arrest the AIDS epidemic could be made through responsible needle exchange and drug treatment programs. Traditionally, AMA policy follows science, and as Secretary Shalala notes scientific evidence clearly shows that needle exchange is effective in curtailing HIV transmission and that the availability of clean needles does not increase drug abuse." (4/20/98)
In order to determine the cost-effectiveness of needle exchange programs, we analyze the following questions:
1. How many Americans contract HIV each year, as a result of dirty needles.
2. What is the percentage impact on infection rates of needle exchange programs.
i.e. how many lives would be saved if such programs were available?
3. What is the cost of these programs per life saved?
4. What is the cost of providing post-infection treatment to people with HIV?
According to CDC statistics (HIV/AIDS Surveillance Report):
In 1996, a total of 68,808 Americans were diagnosed with AIDS. Of these, 24,026 (35%) contracted the disease directly or indirectly via IV drug use.
In addition, 6,062 contracted AIDS from unspecified risk heterosexual contact, and 9,087 where the exposure category was unspecified.
In 1997, a total of 60,634 Americans were diagnosed with AIDS. Of these, 19,463 (32%) contracted the disease directly or indirectly via IV drug use.
In addition, 5,537 contracted AIDS from unspecified risk heterosexual contact, and 13,145 where the exposure category was unspecified.
HHS press release (4/20/98) states:
Since the AIDS epidemic began in 1981, injection drug use has played an increasing role in the spread of HIV and AIDS, accounting for more than 60 percent of AIDS cases in certain areas in 1995. To date, nearly 40 percent of the 652,000 cases of AIDS reported in the U.S. have been linked to injection drug use.
More than 70 percent of HIV infections among women of childbearing age are related either directly or indirectly to injection drug use. And more than 75 percent of babies diagnosed with HIV/AIDS were infected as a direct or indirect result of injection drug use by a parent.
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In March 1997, the National Institutes of Health published the Consensus Development Statement on Interventions to Prevent HIV Risk Behaviors. That report concluded that needle exchange programs "show a reduction in risk behaviors as high as 80 percent in injecting drug users, with estimates of a 30 percent or greater reduction of HIV." The panel also concluded that the preponderance of evidence shows either a decrease in injection drug use among participants or no changes in their current levels of drug use.
According to UC Berkeley/UCSF study in 1993, The Public Health Impact of Needle Exchange Programs in the United States and Abroad for CDC:
Four methods were utilized to assess NEP effectiveness and cost-effectiveness. In the first, the New Haven needle circulation model,[ Kaplan, EH, and O'Keefe, E. Let the needles do the talking! Evaluating the New Haven needle exchange. Interfaces. 1993;23:7-26.] was reviewed and each of its assumptions evaluated. Based on this review, we conclude that the model is a significant, innovative, and sound addition to NEP evaluation efforts. Because it does not include estimates of risk behavior change (other than the act of exchanging), it probably underestimates the true impact of NEPs.
In a second model, a simplified version of the circulation model was combined with data collected for this report to estimate NEP effectiveness and cost-effectiveness in four hypothetical cities. HIV incidence in NEP clients is estimated to decline between 17% and 70% in these hypothetical cities. The cost per HIV infection averted ranges between $12,000 and almost $100,000.
The third model used self-reported behavior change data from a separate study of IDUs in a city similar to one of the four hypothetical cities. An estimated total of 159 infections in NEP clients, their drug and sex partners, and their children would be prevented over five years at a cost per HIV infection averted of approximately $3,800.
The fourth model combined descriptions of HIV risk behaviors from the same dataset with the circulation model, and applied them to the same hypothetical city. This model predicts that, over five years, 64 infections in NEP clients, their drug and sex partners, and their children would be prevented at a cost of approximately $9,400 per HIV infection averted.
According to 1993 Berkeley/UCSF study, The Public Health Impact of Needle Exchange Programs in the United States and Abroad, the average lifetime cost of treating an HIV-infected person was estimated at approximately $119,000.
General stats from 1994 CDC review of UC Berkeley/UCSF NEP report:
Approximately 1/3 of all AIDS cases occur among injections drug users, their sex partners and their children.
Only about 15% of injectors are in drug treatment on any given day.
Over 10,000 drug users, their sex partners and their children contract HIV each year. This is 1-2 preventable HIV infections per hour. Needle exchange may decrease new HIV infections by more than 40%, according to the New Haven mathematical model.
Cost Calculation
The cost to the American taxpayer of our politician's decision not to support a needle exchange program is the difference between the money spent on needle exchange and the money saved by it.
This is calculated as the difference between:
1. The cost of providing post infection treatment to those who become
infected because a needle exchange program is not available.
2. The cost of a needle exchange program
The cost of providing post infection treatment is given by:
(The cost for post infection treatment) multipled by (number of HIV resulting from dirty needles)
multiplied by
(proportion of individuals infected by dirty needles who would have not have become infected if a clean needles were available)
From the data above, for 1997 this gives us a figure of $119,000 * 19,463 * 0.36 = $833,794,000
The cost of a needle exchange program is given by:
(The cost providing clean needles) times (The number of individuals). From the data for 1997 this gives us a figure of $12,000 * 19463 = $233,556.
So the cost to the taxpayers of not funding such programs is $833,794,000 - $233,556,000 or $600,239,000

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