The Cost-Effectiveness of Consistent and Early Intervention of Harm Reduction for Injecting Drug Users in Bangladesh

The authors evaluated the cost-effectiveness of a needle/syringe exchange program, CARE-SHAKTI, operating in Dhaka, Bangladesh. The study included an assessment of CARE-SHAKTI over three years; an additional year relative to cessation; and relative to an increase in HIV prevalence.

Cost data were collected from the intervention site and combined with impact estimates derived from a dynamic mathematical model.

The cost per HIV infection prevented over the initial three years was $110.40 ($33.10-$182.30). The incremental cost of continuing the intervention a further year was $97 relative to ending the intervention if pre-intervention risk behaviors resume. If baseline HIV prevalence among injection drug users (IDU) was increased to 40 percent, the number of HIV infections prevented over three years would be halved, and the cost for each infection prevented would double to $228.

"The analysis confirms that harm reduction activities are cost-effective," concluded the authors. "Early intervention is more cost-effective than delaying activities, although this should not preclude later intervention. Starting harm reduction activities when IDU HIV prevalence reaches as high as 40 percent is still cost-effective. Continuing harm reduction activities once a project has matured is vital to sustaining its impact and cost-effectiveness."

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