Presentation is loading. Please wait.

Presentation is loading. Please wait.

Cost-effectiveness and return on investment of harm reduction programmes for people who inject drugs in Malaysia H. Naning 1, C. Kerr 2, A. Kamarulzaman.

Similar presentations


Presentation on theme: "Cost-effectiveness and return on investment of harm reduction programmes for people who inject drugs in Malaysia H. Naning 1, C. Kerr 2, A. Kamarulzaman."— Presentation transcript:

1 Cost-effectiveness and return on investment of harm reduction programmes for people who inject drugs in Malaysia H. Naning 1, C. Kerr 2, A. Kamarulzaman 1, M. Dahlui 3, CW Ng 3, D. Wilson 2 1 Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia 2 Kirby Institute, University of New South Wales, Sydney, Australia 3 Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia 1

2 HIV Epidemic in Malaysia HIV epidemic in Malaysia mainly concentrated in four key affected populations People who inject drugs (PWID) remain the largest group of people living with HIV in Malaysia (68 per cent of cumulative HIV cases) 2 Source: Ministry of Health, 2012

3 Background Harm reduction as an evidence-based approach to HIV prevention, treatment and care for injecting drug users (WHO, UNODC, UNAIDS) Malaysia adopted harm reduction strategy comprising Methadone Maintenance Therapy (MMT) and Needle-Syringe Exchange Programme (NSEP) –Implemented in stages from 2006 –Expansion underway, but coverage remains limited –Services delivered by governmental and non-governmental agencies (NGOs) –Funded predominantly by the government, supplemented by Global Fund and International HIV/AIDS Alliance Concerns raised that public funding may not be sustainable in the long run –Thus, evidence on the impact and cost effectiveness of harm reduction programmes is needed 3

4 Harm Reduction Coverage MMT Coverage Service delivered by MOH, Prison, National Anti-Drug Agency (NADA), NGOs, private practitioners Expanded from 17 facilities in 2006 to 292 facilities in 2011 By 2011, 20,955 PWIDs had registered to receive free MMT services from public sites and 23,473 registered with private practitioners NSEP Coverage MOH and NGOs as main provider Expanded from 45 centres and outreach points in 2006 to 297 centres and outreach points in 2011 By 2011, 34,244 PWIDs had registered to receive NSEP services 4

5 Aims & Methods Study aims to examine –effectiveness of harm reduction programmes in averting HIV infections –cost-effectiveness of programmes –direct HIV health care cost savings –return of investments on direct HIV health care costs A dynamic compartmental mathematical model (PrevTool) developed by Kirby Institute, University of New South Wales –model simulates the number of people in the population who become infected with HIV over time and the extent of disease progression in terms of CD4 count Model required extensive input of –Epidemiological data –Clinical data –Health care cost data 5 Primary data: Hospital admission expenditure Secondary data: Literature review, hand- searches, data request

6 Direct HIV Health Care Costs Antiretroviral (ARV) for PLHIV with CD4 count < 350 cell/mm 3 Outpatient –Estimate costs by unit cost for services –Frequency of visit, monitoring by CD4 count Inpatient –Cost exercise conducted in main hospital for HIV management in Malaysia –Covers inpatient services for HIV positive PWIDs for HIV related conditions 6

7 RESULT 7

8 Impact of NSEP on HIV Risk Behaviour 8

9 Impact of MMT on Number of Active PWIDs 9

10 HIV Incidence 10 3,100 HIV infections averted

11 Direct HIV Health Care Cost Savings 11 Harm Reduction Programme Total direct health care cost-saving (mil. RM) Combined MMT and NSEP 2.48 (1.97 – 3.01) (29.20 – 48.75) NSEP alone 2.36 (1.88 – 2.87) (27.12 – 45.28) MMT alone 0.17 ( ) 5.77 (4.17 – 748) Direct HIV health care cost savings based on infections averted. USD 1 ≈ RM3.1 Estimates are medians with 95% confidence intervals provided in parentheses

12 Cost effectiveness 12 Harm Reduction Programme Incremental cost effectiveness ratio (RM/QALY gained) Combined MMT and NSEP 18,535 (15,674 – 22,439) 2,358 (1,840 – 3,164) NSEP alone 6,852 (5,704 – 8,331) 627 (423 – 917) MMT alone 171,398 (147,083 – 208,099) 11,661 (9,661 – 15,404) Estimates are medians with 95% confidence intervals provided in parentheses ICER (Incremental cost effectiveness ratio) - cost per QALY (quality- adjusted life years) gained Cost effectiveness threshold – maximum value that society is willing to pay or can afford for a unit of health gain (based on GDP per capita) CE threshold : 3 x GDP per capita (not cost effective). (WHO Commission on Macroeconomics and Health, 2001) Malaysia GDP per capita in 2011 ≈ USD 9,650 ≈ RM29,915

13 Return On Investment 13 Harm Reduction Programme Return on investment Combined MMT and NSEP 0.03 (0.02 – 0.03) 0.13 (0.10 – 0.17) NSEP alone 0.07 (0.06 – 0.09) 0.37 (0.28 – 0.47) MMT alone 0.00 (0.00 – 0.00) 0.03 (0.02 – 0.04) Return measured only in direct HIV health care costs saved (not overall return on investment) Estimates are medians with 95% confidence intervals provided in parentheses

14 Return on Investment 14 Cost savings from direct HIV health care costs relatively small in comparison to investment Public health system main provider of care for PLHIV in Malaysia Use of auxiliary health care staff to provide care, generic pharmaceuticals all contribute to a relatively efficient system ROI only examined impact from health perspective, other associated social benefits such as reduction in illicit of drug use, reduction in criminal activities, employment, society integration were not considered

15 Conclusion 15 Harm reduction programmes in Malaysia –averted HIV infections among people who inject drugs –highly cost effective –produced saving in direct HIV health care costs Strong evidence that MMT and NSEP programmes are an effective and cost- effective strategy for averting HIV infections in Malaysia

16 Acknowledgement 16 Ministry of Health Dr Chong Chee Kheong Dr Sha’ari Ngadiman Dr Fazidah Yusman Sg Buloh Hospital Datuk Dr Christopher Lee Dr Suresh Kumar Dr Benedict Lim Ritta David Masitah Mohd Salleh The study was funded by World Bank National Anti-Drug Agency Dr Sangeeth Kaur University of New South Wales Richard Gray Lei Zhang Josephine Reyes Centre of Excellence for Research in AIDS Theresa Anthony Christine Standley Howie Lim Jeannia Fu Alexander Bazazi

17 Appendix 17

18 Programme Cost 18 Source: Ministry of Health, 2012

19 Parameters *Adapted based on available study and consultation with HIV clinician DataParameters required DemographicIDUs population size Epidemiology HIV prevalence of IDUs Treatment Testing rate per year* Treatment rate per year* Number of HIV diagnosed Number of patients on ART* Behavioural Percentage of shared injections Average number of injections per year Percentage of reused syringes that are cleaned Percentage of IDUs on Methadone 19

20 Parameters 20 DataDescription 1. HIV testingCost per HIV positive IDUs tested 2. ARV cost Average cost per HIV positive IDU had CD4 >350 and CD4 ≤ Outpatient cost Average cost per HIV positive IDU per year 4. Inpatient costAverage cost per HIV positive IDU per year

21 Direct Health Care Costs Category of CD4 counts Annual per capita cost (RM) Inpatient Care Outpatient Care Total (RM) USD CD4<350 cells/mm 3 15,6831,461 17,144 5,530 CD4≥350 cells/mm 3 NA ARV drugs First line Stavudine (d4T), Lamivudine (3TC), Nevirapine (NVP) Combivir (AZT/3TC), Efavirenz (EFV) Combivir (AZT/3TC), Nevirapine (NVP) 2, Second-line Combivir (AZT/3TC) and Kaletra 13,643 4, USD 1 ≈ RM3.1

22 Cost Effectiveness QALY (quality adjusted life years) Incorporate both the prolongation of life and the quality of life by avoiding HIV 22 Harm Reduction Programme Number of QALYs gained Combined MMT and NSEP 4,830 (4,002 – 5,669) 104,116 (80,806 – 124,605) NSEP alone 4,599 (3,807 – 5,400) 96,451 (74,929 – 115,572) MMT alone 338 (279 – 394) 15,602 (11,920 – 18,493) Estimates are medians with 95% confidence intervals provided in parentheses

23 MMT Coverage ( ) 23 By 2011, 20,955 IDUs had registered to receive free MMT services from public sites and 23,473 registered with private practitioner

24 NSEP Coverage (Dec 2010) AgencyNo of NSEP sites NGOs-based (Centre) 17* MOH (Health Clinic) 73 Total90 By 2011, 34,244 IDUs had registered to receive NSEP services from 221 NGO’s outreach points and 76 MOH clinic *Over 200 of outreach points


Download ppt "Cost-effectiveness and return on investment of harm reduction programmes for people who inject drugs in Malaysia H. Naning 1, C. Kerr 2, A. Kamarulzaman."

Similar presentations


Ads by Google