Cost-effectiveness of syringe exchange as an HIV prevention strategy.

OBJECTIVE To analyze the cost-effectiveness of New York State-approved syringe exchange programs (SEPs) and estimate the cost-saving potential of these programs. DESIGN AND METHODS The cost-effectiveness analysis used cost and process data provided by seven SEPs for the calendar year 1996 or the most recent 12-month period available at the time of the study. Alternative estimates of the number of HIV infections prevented were calculated using published data and a simplified circulation model. HIV treatment costs were taken from the literature. RESULTS A cost-effectiveness ratio of $20,947 per HIV infection averted was calculated based on an estimated 87 HIV infections averted across the seven programs and total program costs of $1.82 million (all amounts given in US dollars). Sensitivity analyses were also performed. Using imputed costs for donated services and estimates of lifetime costs to treat an HIV infection, syringe exchange was demonstrated to be a cost-saving strategy from a societal perspective. CONCLUSIONS This research demonstrates that syringe exchange is a cost-effective and cost-saving strategy for reducing HIV transmission.