Reducing the Harm Associated with Injection Drug Use in Canada
3. The Costs
The economic costs associated with injection drug use are substantial. Although a separate estimate of the costs attributable to injection drug use is not available, it is clear that the majority of the total cost attributable to drug use stem from injection drug use. In 1992, before the recent escalation of HIV and hepatitis C infections associated with injection drug use, the costs related to illicit drug use were conservatively estimated at $1.4 billion per year.27 Injection drug use accounted for the majority of the deaths and much of the crime caused by drugs. The largest economic cost ($823 million) was for lost productivity due to morbidity and premature death, and substantial portions of the costs ($400 million) were for law enforcement. The change in drug of choice from heroin to cocaine, for those who inject drugs, is augmenting the urgency of the situation due to the greater frequency of injection associated with cocaine use.
The lifetime average direct cost of providing HIV/AIDS treatment to each person newly infected with HIV who injects drugs is estimated to be $150,000.h,28,29,30 A study estimated that the direct and indirect costs of HIV/AIDS attributed to injection drug use would be $8.7 billion over a six year period if trends continued.31 Another study modeled the impact of a 10% reduction of risk activity resulting from a $200 per person per annum intervention in high risk, high prevalence communities and predicted that 164 HIV infections would be prevented over five years.32 Taken together, the results suggest that an annual investment of $1 million per year over five years could result in a return on investment or savings in subsequent costs of as much as $24 million.
An estimate of the cost to treat a person infected with hepatitis C is not available, but a study of the economic impact of hepatitis C in Canada is currently underway. It is known, however, that treatment with Rebetron, a drug commonly used for hepatitis C, may cost up to $30,000 per course of treatment for an infected individual. A liver transplant may cost up to $250,000.33 According to the Canadian Institute for Health Information, there were 338 liver transplants in Canada in 1998.34
The Medical Research Council estimated in 1999 that 217 of these transplants are attributable to hepatitis C infection. It is anticipated that this figure will triple by 2008 and hepatitis C will become the leading cause of liver transplants.35 Because the prevalence of hepatitis C is much higher than HIV infection, the medical costs to treat it are expected to exceed those for HIV.
h Costs include physician billings, hospital inpatient nights, emergency visits, counseling and formal support, hospital clinic visits, alternative therapy visits, drug costs and lab tests. Residential home care and community home care costs are excluded (Hanvelt, R., Copley, T., Schneider, D. & Meagher, N. The Economic Costs and Resource Impacts of HIV/AIDS in BC (Community Health Resource Project, Sept., 1, 1999). NHRDP Project No. 6610-2372 AIDS)
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