Cost-effectiveness of harm reduction in preventing hepatitis C among injection drug users

Objectives. Hepatitis C (HCV) has emerged as a major epidemic among injection drug users (IDUs), with observed prevalence exceeding 70% in many American and European cities. This article explores the potential of syringe exchange programs (SEPs) to reduce HCV incidence and prevalence. Design. A random-mixing epidemiological model is used to examine the potential impact of harm reduction interventions. Methods. Steady-state analysis is used to scrutinize the impact of SEP on HCV incidence and prevalence and to examine the accuracy of short-term incidence analysis in predicting long-run program effects. Results. SEP is predicted to have little impact on HCV incidence and prevalence within realistic populations of IDUs. Conclusions. Short-term incidence analysis substantially overstates SEP effectiveness and cost-effectiveness in preventing HCV, More comprehensive harm reduction models, coupled with referral of active IDUs to treatment, must complement syringe exchange to successfully contain highly infectious blood-borne diseases.