Xue Hui, Hu Yiyun, Sun Jiangping
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
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Zhonghua Yu Fang Yi Xue Za Zhi. 2014 Apr;48(4):291-5.
To measure related cost, effectiveness and benefit of needle and syringe exchange (NSP) in two provinces of Southwest China.
Between September 2012 and February 2013, program files and questionnaires were used to collect the information about cost, effectiveness and benefit of NSP during three program years (July 2009 to June 2010, July 2010 to June 2011, July 2011 to June 2012 ) in 31 counties of two provinces of Southwest China. Unit cost indicators including cost of providing per syringe and cost of covering per IDU, number of new HIV infections avoided by providing needle and syringe exchange were used to evaluate the effectiveness of NSP, and the benefit indicators included the fees for ART, hospitalization cost and follow up of new HIV infection avoided by NSP. NEAR model was used to calculate the cases averted by NSP. Chi-square test was used to analyze the different percentage of allocation areas between two provinces.
Between July 2009 and June 2012, 25 374 041 yuan were totally used for NSP. In province A, the top investment area was management (1 848 485 yuan) while it was comprehensive intervention (5 452 355 yuan) in province B. The cost of providing per syringe was 3.67 yuan, and it decreased from 6.96 to 4.01 in province A and decreased from 3.38 to 2.17 in province B with the increasing needles distributed. The cost of covering per IDU was 712.71 yuan and the unit cost decreased from 882.85 to 574.95 in province A and decreased from 760.48 to 625.07 in province B with the growing number of IDUs intervened. A total of 1 307 new HIV infection were avoided by providing NSP, so 19 413.96 yuan would be used to avoid per IDU infecting HIV. A total of 367 507 488 yuan of HIV/AIDS related expenditure were avoided by NSP and the cost benefit ratio was 14.48.
NSP has a good cost-benefit ratio and should be promoted.
评估中国西南部两个省份针具交换项目（NSP）的相关成本、效果和效益。
2012年9月至2013年2月，通过项目文件和问卷调查收集中国西南部两个省份31个县在三个项目年度（2009年7月至2010年6月、2010年7月至2011年6月、2011年7月至2012年6月）期间针具交换项目的成本、效果和效益信息。单位成本指标包括提供每支注射器的成本和覆盖每名注射吸毒者的成本，通过提供针具交换避免的新增艾滋病毒感染数用于评估针具交换项目的效果，效益指标包括针具交换项目避免的抗逆转录病毒治疗费用、住院费用和新增艾滋病毒感染的随访费用。采用NEAR模型计算针具交换项目避免的病例数。采用卡方检验分析两个省份之间分配区域的不同百分比。
2009年7月至2012年6月，针具交换项目共使用资金25374041元。在A省，投资最多的领域是管理（1848485元），而在B省则是综合干预（5452355元）。提供每支注射器的成本为3.67元，在A省随着分发针具数量的增加从6.96元降至4.01元，在B省从3.38元降至2.17元。覆盖每名注射吸毒者的成本为712.71元，在A省随着干预注射吸毒者数量的增加单位成本从882.85元降至574.95元，在B省从760.48元降至625.07元。通过提供针具交换项目共避免了1307例新增艾滋病毒感染，因此避免每名注射吸毒者感染艾滋病毒的成本为19413.96元。针具交换项目共避免了367507488元与艾滋病毒/艾滋病相关的支出，成本效益比为14.48。
针具交换项目具有良好的成本效益比，应予以推广。
