Is your syringe services program cost-saving to society? A methodological case study

Background While there is a general acceptance among public health officials and policy-makers that syringe services programs can be effective in reducing HIV transmission among persons who inject drugs, local syringe services programs are often asked to provide economic justifications for their activities. A cost-effectiveness study, estimating the cost of preventing one HIV infection, would be the preferred methods for addressing this economic question, but few local syringe services programs have the needed data, staff and epidemiologic modeling resources needed for a cost–effectiveness study. We present a method for estimating a threshold value for the number of HIV infections prevented above which the program will be cost-saving to society. An intervention is considered “cost-saving” when it leads to a desirable health outcome a lower cost than the alternative. Methods The research literature on the effectiveness of syringe services programs in controlling HIV transmission among persons who inject drugs and guidelines for syringe services program that are “functioning very well” were used to estimate the cost-saving threshold at which a syringe services program becomes cost-saving through preventing HIV infections versus lifetime treatment of HIV. Three steps are involved: (1) determining if HIV transmission in the local persons who inject drugs (PWID) population is being controlled, (2) determining if the local syringe services program is functioning very well, and then (3) dividing the annual budget of the syringe services program by the lifetime cost of treating a single HIV infection. Results A syringe services program in an area with controlled HIV transmission (with HIV incidence of 1/100 person-years or less), functioning very well (with high syringe coverage, linkages to other services, and monitoring the local drug use situation), and an annual budget of $500,000 would need to prevent only 3 new HIV infections per year to be cost-saving. Conclusions Given the high costs of treating HIV infections, syringe services programs that are operating according to very good practices (“functioning very well”) and in communities in which HIV transmission is being controlled among persons who inject drugs, will almost certainly be cost-saving to society.

Abstract 11560: Systematic Deployment of AEDs in BC Schools: A Utility and Cost-Effectiveness Study of In-School and Nearby OHCAs

Background: While pediatric out-of-hospital cardiac arrests (OHCAs) are relatively uncommon, they have a much higher number of potential years of life lost per event. School-located public access automated external defibrillators (AED) may be beneficial to school-aged OHCAs, but also other OHCAs within the school and in the surrounding community. We sought to identify the incidence of OHCAs within and nearby schools in British Columbia (BC), to estimate the number that may benefit from school-located AEDs. Methods: We used prospectively-collected data from the BC OHCA Registry from 2013 to 2018. We examined the addresses of all OHCAs to determine those occurring in public primary and secondary schools. We geo-plotted all OHCAs to identify the number of OHCAs within walking distance of a school. Assuming an average pedestrian speed for AED retrieval of 1.8 m/second, we calculated the number of school-vicinity OHCAs for which a bystander could retrieve an AED prior to a 6.5 minute emergency medical system response interval, assuming that AEDs would be located on the exterior of a school building. Results: There were a total of 401,423 children enrolled at 824 schools annually in the study footprint. Of a total of 12,480 EMS-treated OHCAs (220 aged < 18 years), 20 were in in schools, of which 4 were <18 years of age. Of school located OHCAs, 14 (70%) had initial shockable rhythms, 4 (20%) had an AED applied (of whom 3 survived), and 10 (50%) survived. Of the four school-located pediatric OHCAs, three were witnessed (75%), two had initial shockable rhythms (50%), and two (50%) survived until hospital discharge. A total of 1128/12,480 (9%) OHCAs were within retrieval distance of a school, corresponding to 0.228 per school per year (95% CI 0.201-0.255 year-to-year) , which is above current thresholds for cost-effectiveness. Conclusion: Outcomes of school-located OHCAs are encouraging, especially those with AED application. While the incidence of school-located OHCAs is low, a substantial proportion of OHCAs occur within a retrievable distance to a school, and thus accessible external school-located AEDs may improve overall OHCA outcomes of a community.

The application of best available technology in dealing with Ontario's waste electric and electronic equipment : a case study

This study seeks to inquire into the impacts of pursuing a comprehensive Waste Electrical and Electronic Equipment (WEEE) program similar to the system in the European Union in the Province of Ontario. O. Reg. 393/04 WEEE seeks to establish a weight-based system of recycling end-of-life (EOL) electronics. BAT revenue projections would make for a profitable endeavour across the first five years of the program, with reductions in pollution and operating costs from primary ore refinement. Sensitivity analysis reveals that the BAT scheme profitability exceeds the "do nothing" option across all price ranges (including worst case scenarios), while, at the same time, results in increased susceptibility to market volatility. A cost-effectiveness study showed that the investment in a new integrated smelting operation would still be more cost-effective than the "do nothing" option. This study points to the need for further research into market incentives regarding the amount of collected electronic waste.