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Cost-effectiveness of Harm Reduction in Preventing Hepatitis C among Injection Drug Users

Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan

Objectives. Hepatitis C (HCV) has emerged as a major epidemic among injection drug users (IDUs), with observed prevalence exceeding 70% in many American and European cities. This article explores the potential of syringe exchange programs (SEPs) to reduce HCV incidence and prevalence.Design. A random-mixing epidemiological model is used to examine the potential impact of harm reduction interventions. Methods. Steady-state analysis is used to scrutinize the impact of SEP on HCV incidence and prevalence and to examine the accuracy of short-term incidence analysis in predicting long-run program effects. Results. SEP is predicted to have little impact on HCV incidence and prevalence within realistic populations of IDUs. Conclusions. Short-term incidence analysis substantially overstates SEP effectiveness and cost-effectiveness in preventing HCV. More comprehensive harm reduction models, coupled with referral of active IDUs to treatment, must complement syringe exchange to successfully contain highly infectious blood-borne diseases.

Key Words: harm reduction • cost-effectiveness • epidemiological models • hepatitis C • syringe and needle exchange • HIV • injection drug use

Medical Decision Making, Vol. 21, No. 5, 357-367 (2001)
DOI: 10.1177/0272989X0102100502


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