Contents

• Issue 46 December 09
• Money Well Spent
• Cannabis
• The Woolshed and After
• Peer Education
• HBVaccine
• Great Liver Food
• A Strategy for Hepatitis B
• Sharing Ideas in Beautiful Hobart
• Mascot Madness
• Vending Machine Trial
• Open Your Mind
• Love Your Liver Lunch
• eBox Update

Money Well Spent

Every dollar spent on Australia’s needle and syringe programs (NSPs) saves state and federal budgets four dollars by preventing life-threatening infections. These significant findings were part of the October-released report Return on Investment 2: Evaluating the cost-effectiveness of needle and syringe programs in Australia, which was commissioned by the Australian Department of Health and Ageing.

The team from the University of NSW who wrote the report found that the 30 million needles and syringes distributed every year in Australia since the year 2000 have directly prevented more than 32,000 cases of HIV infection, and almost 100,000 cases of hepatitis C, representing a saving in healthcare costs of almost $1.2 billion.

Researchers at UNSW’s National Centre in HIV Epidemiology and Clinical Research, led by Associate Professor David Wilson, used a range of clinical, behavioural and economic data to analyse how effective NSPs have been in preventing the life-threatening infections HIV and hepatitis C, which are easily transmitted when people who inject illicit drugs do not have access to sterile injecting equipment.

From 2000 to 2009, this program cost a total of $243 million. The national needle and syringe program is made up of nearly 1000 sites around the country, including outlets, clinics, pharmacies and vending machines, which distribute sterile injecting equipment.

In our state, the Clean Needle Program operated by the Drug and Alcohol Services South Australia, commenced in 1989. Pharmacy programs in SA for distributing needles and syringes commenced in the early 1990s. South Australia has 81 CNPs, consisting of one primary outlet, 69 secondary outlets and 11 enhanced secondary outlets, in both metropolitan Adelaide and in rural areas. There are over 170 pharmacies that sell needles and syringes on a commercial basis. Some outreach services are also provided. Disposal facilities are provided at all community CNP sites, most pharmacies and some local councils also provide disposal facilities.

The proportion of Australian users of injecting drugs that are in South Australia has remained relatively steady. The number of needles and syringes distributed through CNPs in South Australia increased during 2002-2004 but has started to decline in recent years. The average frequency of injecting by IDUs in South Australia has remained steady but sharing rates have tended to increase slightly. Despite this, the prevalence of HCV among South Australian IDUs has been steady, with a slight tendency for a decrease which is in contrast to most other jurisdictions. The incidence of HIV has remained relatively low among South Australian IDUs.

The spending of $15m in the funding of CNPs in South Australia from year 2000-2009 has resulted in a saving of $93m in healthcare costs. The mathematical and economic modelling estimated that if CNPs are continued at the same level of funding in SA for the next ten years, $295m of net financial savings will accrue, and for twenty years it will be $605m.

“As well as the health care savings, NSPs have given us substantial gains in quality and length of life in Australia,” explained the study’s health economist, Dr Jonathan Anderson. “The infections prevented by the program [mean that many] people lived in better health for longer”.

Associate Professor Wilson said that “after more than two decades of successful operation, NSPs remain a cornerstone of Australia’s HIV prevention strategy and a primary reason for why we have largely contained the epidemic in this country. Additionally, Australia’s NSPs have proven to be a foundation for preventing transmission of the more infectious hepatitis C virus.

“This study provides strong evidence to suggest that increased spending should be invested in expanding NSPs. Not only would it significantly reduce health burdens, but it will ultimately save Australian taxpayers substantial amounts of money.”

The report indicates that an additional 50% increase in distribution of sterile injecting equipment could lead to maximal returns, yielding a further 37% decrease in HIV and 23% decrease in hepatitis C cases over the next 10 years.

For more information, read the report in the HCCSA Library, or else download it at www.hepc.org.au/documents/2009ROI-2MB.pdf.