ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2024
Cost-benefit analysis of Canada's Prison Needle Exchange Program for the prevention of hepatitis C and injection-related infections.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Best practice guidelines for viral hepatitis service delivery in prisons.The Lancet. Infectious diseases · 2026Pooled it
- Drug use among people in prison: A global review of epidemiology, harms and interventions.Addiction (Abingdon, England) · 2026Pooled it
- Gatekeeping harm reduction in Canadian Federal Prisons: Perspectives on the threat risk assessment for the prison needle exchange program by prison administrative leadership.Addiction (Abingdon, England) · 2026Article
- Hospital-Admitted Injection-Related Infections Among Incarcerated People Who Inject Drugs in Australia: A Retrospective Cohort Study.The Medical journal of Australia · 2026Observational
- Enhancing uptake of the Canadian Prison Needle Exchange Program using a non-randomized stepped-wedge cluster type 1 hybrid implementation trial: The NEXUS study protocol.Contemporary clinical trials communications · 2026Article
- Harm reduction and pharmacy practice: a scoping review of services for people who use drugs provided by pharmacy staff.BMJ open · 2026Article
- The 14th Canadian Symposium on Hepatitis C Virus: From research breakthroughs to equitable health care for priority populations.Canadian liver journal · 2025Article
- Trends in hepatitis C care in Canada's provincial and territorial prisons from 2020 to 2024.Canadian liver journal · 2025Article
- Using the socioecological model to guide service delivery improvements to the prison needle exchange program in Canada: insights from multi-level stakeholders.BMC public health · 2025Article
- The costs and benefits of a prison needle and syringe program in Australia, 2025-30: a modelling study.The Medical journal of Australia · 2025Article
- Article
- Improving implementation of needle and syringe programmes to expand, scale up, and sustain evidence-based prevention interventions for HIV and hepatitis C in prisons.The Lancet. Public health · 2025Article
- The burden of drug overdose deaths among correctional populations: implications for interventions.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2024Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundNeedle exchange programs are effective public health interventions that reduce blood-borne infections, including hepatitis C, and injection-related infections. We sought to assess the return on investment of existing Prison Needle Exchange Programs (PNEPs) in Canadian federal prisons and their expansion to all 43 institutions.
methodsWe developed a stochastic compartmental model that estimated hepatitis C and injection-related infections under different PNEP scenarios in Canadian federal prisons. Scenarios projected for 2018-2030 were no PNEP, status quo (actual PNEP implementation 2018-2022, with coverage maintained to 2030), and PNEP scale-up (coverage among people who inject drugs in prison increasing over 2025-2030 to reach 50% by 2030). We calculated the benefit-cost ratio as benefits from health care savings, divided by PNEP costs.
resultsBy 2019, PNEPs were implemented in 9 of 43 federal prisons, with uptake reaching 10% of people who injected drugs in prison in 2022. Compared with no PNEP, this was estimated to cost Can$0.45 (uncertainty interval [UI] $0.32 to $0.98) million and avert 37 (UI 25 to 52) hepatitis C and 8 (UI -1 to 16) injection-related infections over 2018-2030, with a benefit-cost ratio of 1.9 (UI 0.56-3.0). Compared with the status quo, the PNEP scale-up scenario cost an additional $2.7 (UI $1.8 to $7.0) million and prevented 224 (UI 218 to 231) hepatitis C and 77 (UI 74 to 80) injection-related infections, with a benefit-cost ratio of 2.0 (UI 0.57 to 3.3).
interpretationEvery dollar invested in the current PNEP or its expansion is estimated to save $2 in hepatitis C and injection-related infection treatment costs. This return on investment strongly supports ongoing maintenance and scale-up of the PNEP in Canada from an economic perspective.
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