• Farah Houdroge, Nadine Kronfli, Mark Stoové, and Nick Scott.
• Disease Elimination Program (Houdroge, Stoové, Scott), Burnet Institute, Melbourne, Australia; Division of Infectious Diseases and Chronic Viral Illness Service (Kronfli), Department of Medicine, McGill University Health Centre; Centre for Outcomes Research and Evaluation (Kronfli), Research Institute of the McGill University Health Centre, Montréal, Que.; School of Public Health and Preventive Medicine (Stoové, Scott), Monash University, Melbourne, Australia. farah.houdroge@burnet.edu.au.
• CMAJ. 2024 Dec 15; 196 (43): E1401E1412E1401-E1412.

BackgroundNeedle 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.MethodsWe 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.ResultsBy 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).InterpretationEvery 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.© 2024 CMA Impact Inc. or its licensors.

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