Skip to main content
PMC home page
Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 2004 Dec;81(4):655–660. doi: 10.1093/jurban/jth148

The cost of inaction on HIV transmission among injection drug users and the potential for effective interventions

Laura M Kuyper 1, Robert S Hogg 1,2, Julio S G Montaner 1,3, Martin T Schechter 1,2, Evan Wood 1,2,✉
PMCID: PMC3455935  PMID: 15466846

Abstract

Estimated and potential medical costs of treating patients infected with human immunodeficiency virus (HIV) in urban areas of high HIV prevalence have not been well defined. We estimated the total medical cost of HIV disease among injection drug users in Vancouver, British Columbia, Canada, assuming stable and increasing HIV prevalence. Total medical costs were estimated by multiplying the average lifetime medical cost per person by the number of HIV-infected individuals. We assumed the cost of each HIV infection to be $150,000 (Canadian), based on empirical data, and HIV prevalence estimates were derived from the Vancouver Injection Drug Users Study (VIDUS) and external data sources. By use of Monte Carlo simulation methodology, we performed sensitivity analyses to estimate total medical cost, assuming the HIV prevalence remained stable at 31% and under a scenario in which the prevalence rose to 50%. Expected medical expenditures based on current HIV prevalence levels were estimated as $215,852,613. If prevalence rises to 50% as reported in other urban centers, the median estimated medical cost would be approximately $348,935,865. This represents a difference in the total costs between the two scenarios of $133,083,253. Health planners should consider that predicted medical expenditures related to the HIV epidemic among injection drug users in our setting may cost an estimated $215,852,613. If funding cannot be found for appropriate prevention interventions and the prevalence rises to 50%, a further $133,083,253 may be required.

Keywords: AIDS, Cost, Health care, HIV, Injection drug use

Full Text

The Full Text of this article is available as a PDF (67.3 KB).

References

  • 1.French MT, McGeary KA, Chitwood DD, McCoy CB. Chronic illicit drug use, health services utilization and the cost of medical care. Soc Sci Med. 2000;50:1703–1713. doi: 10.1016/S0277-9536(99)00411-6. [DOI] [PubMed] [Google Scholar]
  • 2.Mor V, Fleishman JA, Dresser M, Piette J. Variation in health service use among HIV-infected patients. Med Care. 1992;30:17–29. doi: 10.1097/00005650-199201000-00002. [DOI] [PubMed] [Google Scholar]
  • 3.Seage GR, 3rd, Hertz T, Stone VE, Epstein AM. The effects of intravenous drug use and gender on the cost of hospitalization for patients with AIDS. J Acquir Immune Defic Syndr. 1993;6:831–839. [PubMed] [Google Scholar]
  • 4.Sambamoorthi U, Warner LA, Crystal S, Walkup J. Drug abuse, methadone treatment, and health services use among injection drug users with AIDS. Drug Alcohol Depend. 2000;60:77–89. doi: 10.1016/S0376-8716(99)00142-8. [DOI] [PubMed] [Google Scholar]
  • 5.Palepu A, Tyndall MW, Leon H, et al. Hospital utilization and costs in a cohort of injection drug users. CMAJ. 2001;165:415–420. [PMC free article] [PubMed] [Google Scholar]
  • 6.Palepu A, Strathdee SA, Hogg RS, et al. The social determinants of emergency department and hospital use by injection drug users in Canada. J Urban Health. 1999;76:409–418. doi: 10.1007/BF02351499. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Solomon L, Frank R, Vlahov D, Astemborski J. Utilization of health services in a cohort of intravenous drug users with known HIV-1 serostatus. Am J Public Health. 1991;81:1285–1290. doi: 10.2105/ajph.81.10.1285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Weber AE, Yip B, O’Shaughnessy MV, Montaner JS, Hogg RS. Determinants of hospital admission among HIV-positive people in British Columbia. CMAJ. 2000;162:783–786. [PMC free article] [PubMed] [Google Scholar]
  • 9.Craib KJ, Spittal PM, Wood E, et al. Risk factors for elevated HIV incidence among Aboriginal injection drug users in Vancouver. CMAJ. 2003;168:19–24. [PMC free article] [PubMed] [Google Scholar]
  • 10.Kral AH, Bluthenthal RN, Booth RE, Watters JK. HIV seroprevalence among streetrecruited injection drug and crack cocaine users in 16 US municipalities. Am J Public Health. 1998;88:108–113. doi: 10.2105/ajph.88.1.108. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Kral AH, Lorvick J, Gee L, et al. Trends in human immunodeficiency virus seroincidence among street-recruited injection drug users in San Francisco, 1987–1998. Am J Epidemiol. 2003;157:915–922. doi: 10.1093/aje/kwg070. [DOI] [PubMed] [Google Scholar]
  • 12.Strathdee SA, Patrick DM, Currie SL, et al. Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS. 1997;11:F59–F65. doi: 10.1097/00002030-199708000-00001. [DOI] [PubMed] [Google Scholar]
  • 13.Spittal PM, Craib KJ, Wood E, et al. Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver. CMAJ. 2002;166:894–899. [PMC free article] [PubMed] [Google Scholar]
  • 14.Nicolosi A, Leite ML, Molinari S, Musicco M, Saracco A, Lazzarin A. Incidence and prevalence trends of HIV infection in intravenous drug users attending treatment centers in Milan and northern Italy, 1986–1990. J Acquir Immune Defic Syndr. 1992;5:365–373. [PubMed] [Google Scholar]
  • 15.Jarlais DC, Friedman SR, Sotheran JL, et al. Continuity and change within an HIV epidemic. Injecting drug users in New York City, 1984 through 1992. JAMA. 1994;271:121–127. doi: 10.1001/jama.271.2.121. [DOI] [PubMed] [Google Scholar]
  • 16.Albert T, Williams G. The Economic Burden of HIV/AIDS in Canada. Ottawa, ON: Canadian Policy Research Network; 1998. pp. 38–38. [Google Scholar]
  • 17.Hanvelt R, Copley T, Schneider D, Meagher N. The Economic Costs and Resource Impacts of HIV/AIDS in British Columbia. Vancouver, BC, Canada: Health Canada-National Health Research and Development Program; 1999. [Google Scholar]
  • 18.Tyndall MW, Currie S, Spittal P, et al. Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS. 2003;17:887–893. doi: 10.1097/00002030-200304110-00014. [DOI] [PubMed] [Google Scholar]
  • 19.Hogg RS, Weber AE, Craib KJ, et al. One world, one hope: the cost of providing antiretroviral therapy to all nations. AIDS. 1998;12:2203–2209. doi: 10.1097/00002030-199816000-00016. [DOI] [PubMed] [Google Scholar]
  • 20.Wood E, Braitstein P, Montaner JS, et al. Extent to which low-level use of antiretroviral treatment could curb the AIDS epidemic in sub-Saharan Africa. Lancet. 2000;355:2095–2100. doi: 10.1016/S0140-6736(00)02375-8. [DOI] [PubMed] [Google Scholar]
  • 21.Montaner JS, Hogg RS, Weber AE, Anis AH, O’Shaughnessy MV, Schechter MT. The costs of triple-drug anti-HIV therapy for adults in the Americas [letter] JAMA. 1998;279:1263–1264. doi: 10.1001/jama.279.16.1263-a. [DOI] [PubMed] [Google Scholar]
  • 22.Wood E, Schechter MT, Tyndall MW, Montaner JS, O’Shaughnessy MV, Hogg RS. Antiretroviral medication use among injection drug users: two potential futures. AIDS. 2000;14:1229–1235. doi: 10.1097/00002030-200006160-00021. [DOI] [PubMed] [Google Scholar]
  • 23.Wang J. Components of difference in HIV seropositivity rate among injection drug users between low-and high-HIV-prevalence regions. AIDS Behav. 2003;7:1–8. doi: 10.1023/A:1022541504943. [DOI] [PubMed] [Google Scholar]
  • 24.Ouellet LJ, Thorpe LE, Huo D, et al. Prevalence and incidence of HIV among out-of-treatment injecting drug users, Chicago 1994–1996. J Acquir Immune Defic Syndr. 2000;25:443–450. doi: 10.1097/00042560-200012150-00010. [DOI] [PubMed] [Google Scholar]
  • 25.Stein MD. Injected-drug use: complications and costs in the care of hospitalized HIV-infected patients. J Acquir Immune Defic Syndr. 1994;7:469–473. [PubMed] [Google Scholar]
  • 26.Stein MD. Medical complications of intravenous drug use. J Gen Intern Med. 1990;5:249–257. doi: 10.1007/BF02600544. [DOI] [PubMed] [Google Scholar]
  • 27.Brettle RP, Willcocks L, Cowan FM, Richardson AM. Inpatient health care utilization for patients with HIV and AIDS in the Edinburgh City Hospital. Int J STD AIDS. 1994;5:194–201. doi: 10.1177/095646249400500308. [DOI] [PubMed] [Google Scholar]
  • 28.Kerr T, Wood E, Small D, Palepu A, Tyndall MW. Potential use of safer injecting facilities among injection drug users in Vancouver’s Downtown Eastside. CMAJ. 2003;169: Onelin-1–Online-5. [PMC free article] [PubMed]
  • 29.Wood E, Hogg RS, Yip B, Harrigan PR, O’Shaughnessy MV, Montaner JSG. Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4+cell count is 0.200 to 0.350×109 cells/L. Ann Intern Med. 2003;139:810–816. doi: 10.7326/0003-4819-139-10-200311180-00008. [DOI] [PubMed] [Google Scholar]
  • 30.Wood E, Kerr T, Small W, Jones J, Schechter MT, Tyndall MW. The impact of a police presence on access to needle exchange programs. J Acquir Immune Defic Syndr. 2003;34:116–118. doi: 10.1097/00126334-200309010-00019. [DOI] [PubMed] [Google Scholar]
  • 31.Wood E, Spittal P, Small W, et al. Displacement of Canada’s largest public illicit drug market in response to a police crackdown. CMAJ. 2004;170:1551–1556. doi: 10.1503/cmaj.1031928. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Wood E, Kerr T, Montaner JSG, et al. Rationale for evaluating North America’s first medically supervised safer-injecting facility. Lancet Infect Dis. 2004;4:301–306. doi: 10.1016/S1473-3099(04)01006-0. [DOI] [PubMed] [Google Scholar]
  • 33.Zaric GS, Barnett PG, Brandeau ML. HIV transmission and the cost-effectiveness of methadone maintenance. Am J Public Health. 2000;90:1100–1111. doi: 10.2105/AJPH.90.7.1100. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Needle RH, Coyle SL, Normand J, Lambert E, Cesari H. HIV prevention with drugusing populations: current status and future prospects. Public Health Rep. 1998;113:4–18. [PMC free article] [PubMed] [Google Scholar]
  • 35.Barnett PG. The cost-effectiveness of methadone maintenance as a health care intervention. Addiction. 1999;94:479–488. doi: 10.1046/j.1360-0443.1999.9444793.x. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Urban Health : Bulletin of the New York Academy of Medicine are provided here courtesy of New York Academy of Medicine

RESOURCES