Return on Investment and Cost-Effectiveness of Harm Reduction Program in Malaysia
2014
Naning, Herlianna | Kerr, Cliff | Kamarulzaman, Adeeba | Osornprasop, Sutayut | Dahlui, Maznah | Ng, Chiu-Wan | Wilson, David P.
Cases of human immunodeficiency virus (HIV) infections were first detected in Malaysia in 1986. Since then, the number of new HIV cases has been increasing steadily to a peak of 6,978 new cases detected in 2002 then declining to 3,438 new cases in 2012. In response to the escalating epidemic, the Government of Malaysia (GOM) agreed the implementation of needle syringe program (NSP) and methadone maintenance therapy (MMT) programs against much public opposition which viewed these programs as being against the Islamic religion and will encourage more people to use drugs. The main objectives of this study are to evaluate whether the harm reduction program in Malaysia is cost-effective and also whether they provide return on investments (ROIs) to the government. The study used an epidemiologic mathematical model of HIV transmission and disease progression, called the projection and evaluation tool (Prevtool) developed by a team of investigators at the Kirby Institute, University of New South Wales, Australia to simulate the impact of MMT and NSP on the transmission of HIV among people who inject drugs (PWIDs) in Malaysia. Briefly, the model simulates the number of PWID who become infected with HIV over time as well as the extent of disease progression among those infected in the presence and absence of harm reduction program in the country. This study has shown that the combined MMT and NSP programs as implemented in Malaysia are cost-effective and are expected to produce net cost-savings to the government in the future. Evidence of cost-effectiveness and expected cost-savings support policy recommendation that both MMT and NSP programs should be maintained as part of the key strategy to control HIV spread among PWIDs in Malaysia. Study findings that even with the present program coverage, harm reduction activities are expected to become more cost-effective and cost-saving in the future suggest that policies towards program expansion may demonstrate higher value for money.
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