Cost-benefit analysis of Canada's Prison Needle Exchange Program for the prevention of hepatitis C and injection-related infections.

BACKGROUND

Needle exchange programs are effective public health interventions that reduce blood-borne infections, including hepatitis C, and injection-related infections. We sought to assess the return on investment of existing Prison Needle Exchange Programs (PNEPs) in Canadian federal prisons and their expansion to all 43 institutions.

METHODS

We developed a stochastic compartmental model that estimated hepatitis C and injection-related infections under different PNEP scenarios in Canadian federal prisons. Scenarios projected for 2018-2030 were no PNEP, status quo (actual PNEP implementation 2018-2022, with coverage maintained to 2030), and PNEP scale-up (coverage among people who inject drugs in prison increasing over 2025-2030 to reach 50% by 2030). We calculated the benefit-cost ratio as benefits from health care savings, divided by PNEP costs.

RESULTS

By 2019, PNEPs were implemented in 9 of 43 federal prisons, with uptake reaching 10% of people who injected drugs in prison in 2022. Compared with no PNEP, this was estimated to cost Can$0.45 (uncertainty interval [UI] $0.32 to $0.98) million and avert 37 (UI 25 to 52) hepatitis C and 8 (UI -1 to 16) injection-related infections over 2018-2030, with a benefit-cost ratio of 1.9 (UI 0.56-3.0). Compared with the status quo, the PNEP scale-up scenario cost an additional $2.7 (UI $1.8 to $7.0) million and prevented 224 (UI 218 to 231) hepatitis C and 77 (UI 74 to 80) injection-related infections, with a benefit-cost ratio of 2.0 (UI 0.57 to 3.3).

INTERPRETATION: Every dollar invested in the current PNEP or its expansion is estimated to save $2 in hepatitis C and injection-related infection treatment costs. This return on investment strongly supports ongoing maintenance and scale-up of the PNEP in Canada from an economic perspective.