A recent study in the Canadian Medical Association Journal evaluates the cost-benefit analysis of Canada’s Prison Needle Exchange Program (PNEP), showing that investment in the program can yield public health benefits. The analysis finds that PNEPs reduce hepatitis C and injection-related infections, with each dollar invested saving $2 in treatment costs.1
The study assessed PNEP effectiveness in Canadian federal prisons and the potential benefits of expanding the program across all 43 institutions. The researchers modeled three scenarios for the years 2018–2030: no PNEP, current PNEP implementation, and a scaled-up PNEP, projecting impacts on hepatitis C and injection-related infections.1
Currently, nine of Canada’s 43 federal prisons have implemented PNEPs, with 10% of people who inject drugs in prison reached by 2022. The study found that this limited program prevented 37 cases of hepatitis C and 8 cases of injection-related infections between 2018 and 2030, for Can$.45 million, yielding a benefit–cost ratio of 1.9.1
Expanding PNEP to cover 50% of people who inject drugs in prison by 2030 would cost an additional $2.7 million but could prevent 224 hepatitis C infections and 77 injection-related infections, yielding a benefit–cost ratio of two.1
"We estimated that every dollar spent on the current implementation or further scale-up of the PNEP across all federal prisons could save $2 in reduced costs for infection treatment. Sensitivity analyses suggested that greater economic benefits could be achieved in settings with high hepatitis C incidence, longer sentence lengths, or higher incarceration rates of people with a history of injecting drug use. This return on investment strongly supports ongoing maintenance and scale-up of the PNEP in Canada, from an economic perspective,” the investigators wrote.1
The study has several limitations. First, the model applied consistent parameters across all prisons, regardless of location or security level. Second, it used data from federal prisons, which may not fully represent conditions in provincial prisons. Third, cost estimates for treating injection-related infections were based on limited data from Saskatchewan, which may not be generalizable. Fourth, the model assumed PNEPs fully eliminate the risk of hepatitis C, which may not capture all needle-sharing behaviors. There are additional limitations related to model design, broader transmission dynamics, and uncertainty in the estimates.1
What You Need To Know
Every dollar invested in Canada’s Prison Needle Exchange Program (PNEP) saves $2 in treatment costs by reducing hepatitis C and injection-related infections.
Expanding PNEP to cover 50% of people who inject drugs in prison by 2030 could prevent 224 hepatitis C and 77 injection-related infections, further improving cost-effectiveness.
The study supports the continued maintenance and potential expansion of PNEP as a cost-effective strategy to improve public health and reduce the transmission of blood-borne diseases in Canadian federal prisons.
The incidence rates for hepatitis C has increased significantly in rural areas across the US. One study pointed out that the number of cases had more than double in rural areas vs urban areas. This increase has also been linked to injection drug use with 75% of the individuals followed in the study having reported engaged in this activity.2
“Hepatitis C causes liver cancer, loss of productivity, diabetes and all kinds of complications that cost lives and money. And it’s transmissible, so every time a patient is cured, we also prevent multiple transmissions to other people, Andrew Seaman, MD,in a recent interview with Contagion.”2
In a recent interview with Joseph Friedman, MD, PhD, MPH he emphasized the importance of addressing opioid use and infectious disease prevention within broader public health strategies, “Syringe exchanges, and teaching safe injection practices are, of course, an important and evidence-based strategy. Also, given that we are now in the era where HCV is a curable condition, we need to greatly expand access to curative treatment, to reduce the continued spread of the disease. There are many individuals living with HCV, especially those who use drugs, who are unable to access treatment due to logistical, bureaucratic, and/or financial barriers.”3
These findings highlight the economic and public health benefits of maintaining and expanding PNEPs in Canadian prisons, offering a cost-effective solution to reduce the transmission of blood-borne diseases and improve the health of incarcerated individuals.
References
1. Houdroge F, Kronfli N, Stoové M, Scott N. Cost–benefit analysis of Canada’s Prison Needle Exchange Program for the prevention of hepatitis C and injection-related infections. CMAJ. 2024;196(43):E1401-E1412. . Accessed December 18, 2024. doi:10.1503/cmaj.240648
3. Friedman J, Abramovitz D, Skaathun B, et. al. Illicit Fentanyl Use and Hepatitis C Virus Seroconversion Among People Who Inject Drugs in Tijuana and San Diego: Results From a Binational Cohort Study, Clinical Infectious Diseases, Volume 79, Issue 4, 15 October 2024, Pages 1109–1116. July 30, 2024. Accessed December 18, 2024. https://doi.org/10.1093/cid/ciae372
