温哥华受监管注射设施的成本效益。
The cost-effectiveness of Vancouver's supervised injection facility.
作者信息
Bayoumi Ahmed M, Zaric Gregory S
机构信息
The Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.
出版信息
CMAJ. 2008 Nov 18;179(11):1143-51. doi: 10.1503/cmaj.080808.
BACKGROUND
The cost-effectiveness of Canada's only supervised injection facility has not been rigorously evaluated. We estimated the impact of the facility on survival, rates of HIV and hepatitis C virus infection, referral to methadone maintenance treatment and associated costs.
METHODS
We simulated the population of Vancouver, British Columbia, including injection drug users and persons infected with HIV and hepatitis C virus. The model used a time horizon of 10 years and the perspective of the health care system. We compared the situation of the supervised injection facility with one that had no facility but that had other interventions, such as needle-exchange programs. The effects considered were decreased needle sharing, increased use of safe injection practices and increased referral to methadone maintenance treatment. Outcomes included life-years gained, costs, and incremental cost-effectiveness ratios discounted at 5% per year.
RESULTS
Focusing on the base assumption of decreased needle sharing as the only effect of the supervised injection facility, we found that the facility was associated with an incremental net savings of almost $14 million and 920 life-years gained over 10 years. When we also considered the health effect of increased use of safe injection practices, the incremental net savings increased to more than $20 million and the number of life-years gained to 1070. Further increases were estimated when we considered all 3 health benefits: the incremental net savings was more than $18 million and the number of life-years gained 1175. Results were sensitive to assumptions related to injection frequency, the risk of HIV transmission through needle sharing, the frequency of safe injection practices among users of the facility, the costs of HIV-related care and of operating the facility, and the proportion of users who inject in the facility.
INTERPRETATION
Vancouver's supervised injection site is associated with improved health and cost savings, even with conservative estimates of efficacy.
背景
加拿大唯一的受监管注射设施的成本效益尚未得到严格评估。我们估计了该设施对生存率、艾滋病毒和丙型肝炎病毒感染率、转介接受美沙酮维持治疗以及相关成本的影响。
方法
我们模拟了不列颠哥伦比亚省温哥华的人口情况，包括注射吸毒者以及感染艾滋病毒和丙型肝炎病毒的人群。该模型采用了10年的时间范围，并从医疗保健系统的角度进行分析。我们将有受监管注射设施的情况与没有该设施但有其他干预措施（如针头交换计划）的情况进行了比较。考虑的影响因素包括针头共用减少、安全注射做法的使用增加以及转介接受美沙酮维持治疗的增加。结果包括获得的生命年数、成本以及按每年5%贴现的增量成本效益比。
结果
以针头共用减少作为受监管注射设施的唯一效果这一基本假设为重点，我们发现该设施在10年内带来了近1400万美元的增量净节省，并使生命年数增加了920个。当我们还考虑到安全注射做法使用增加所带来的健康影响时，增量净节省增加到2000多万美元，生命年数增加到1070个。当我们考虑所有三项健康益处时，估计会有进一步增加：增量净节省超过1800万美元，生命年数增加到1175个。结果对与注射频率、通过针头共用传播艾滋病毒的风险、设施使用者中安全注射做法的频率、艾滋病毒相关护理和设施运营成本以及在设施内注射的使用者比例等相关的假设较为敏感。
解读
即使对疗效进行保守估计，温哥华的受监管注射点仍与健康改善和成本节省相关。
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