2014年-世界发展银行全球_Return_on_Investment_and_Cost-Effectiveness_of_Harm_Reduction_Program_in_Malaysia_90页_3mb

Summary of "Return on Investment and Cost-Effectiveness of Harm Reduction Programme in Malaysia"

Core Content

This report, conducted under the World Bank's technical assistance to Malaysia as part of the Malaysia AIDS Support II project (P133134), evaluates the economic impact and cost-effectiveness of the Harm Reduction Programme in Malaysia, specifically focusing on the Needle Syringe Programme (NSP) and Methadone Maintenance Therapy (MMT) interventions. The study aims to demonstrate the value of these programmes in reducing HIV transmission and saving healthcare costs, thus supporting policy decisions and resource allocation.

Main Objectives

• To assess the cost-effectiveness of the NSP and MMT programmes from the perspective of the Government of Malaysia (GOM).
• To estimate the direct healthcare cost savings and the return on investment (ROI) of the harm reduction programme.
• To evaluate the long-term epidemiological and economic benefits of these programmes over different time horizons (2006–2013, 2013–2023, and 2006–2050).

Key Findings

Impact on Disease Burden

• Infections Averted:
  • From 2006 to 2013: 12,653 infections averted.
  • From 2013 to 2023: 23,241 infections averted.
  • From 2006 to 2050: 103,717 infections averted.
• HIV Prevalence Reduction: The harm reduction programme significantly reduced the prevalence of HIV among people who inject drugs (PWID), with the most substantial impact observed in the long-term projections.
• Mortality Reduction: The programme contributed to a reduction in HIV-related mortality, which is a key indicator of its effectiveness.

Quality of Life Effects

• Quality-Adjusted Life Years (QALYs) Gained:
  • From 2006 to 2013: 51,565 QALYs gained.
  • From 2013 to 2023: 393,526 QALYs gained.
  • From 2006 to 2050: 2,164,809 QALYs gained.
• The NSP programme alone showed greater gains in QALYs compared to MMT, indicating its significant role in improving the quality of life for PWID.

Direct Healthcare Cost Savings

• Cost Savings (in RM million):
  • From 2006 to 2013: RM47.06.
  • From 2013 to 2023: RM209.53.
  • From 2006 to 2050: RM909.47.
• The cost savings increase with time, showing the long-term economic benefits of the harm reduction programme.

Cost-Effectiveness and ROI

• Incremental Cost-Effectiveness Ratio (ICER):
  • Combined NSP and MMT: RM1,482 per QALY gained (2006–2050).
  • NSP only: Cost-effective in all time frames.
  • MMT only: Cost-effective but not cost-saving in the short term, with projected improvement in cost-effectiveness over time.
• Return on Investment (ROI):
  • Combined NSP and MMT: RM1.13 (2006–2050).
  • NSP only: RM3.35 (2006–2050).
  • MMT only: RM0.49 (2006–2050).
• The ROI indicates that the harm reduction programme is beneficial and provides value for money, especially when NSP and MMT are implemented together.

Key Information

• Programme Overview:
  • The harm reduction programme in Malaysia includes NSP and MMT.
  • NSP was initially implemented by NGOs and later expanded to include MOH clinics.
  • MMT started with a limited number of public and private sites and has since expanded to include prisons and NADA.
• Government Expenditure:
  • From 2006 to 2011, the GOM invested RM69.3 million in the harm reduction programme.
  • In 2008, the programme accounted for 12.6% of the total public expenditure on the national AIDS programme.
  • By 2011, the programme accounted for 13.0% to 16.5% of the annual total AIDS public expenditures.
• Economic Appraisal:
  • The study highlights that the harm reduction programme is cost-effective and provides significant healthcare cost savings.
  • The programme is aligned with the "better for less" approach advocated by WHO and UNAIDS.
  • The economic benefits of the programme are substantial, with projections indicating long-term savings and improved health outcomes.

Methodology

• Population Model: A mathematical model was used to simulate the impact of NSP and MMT on HIV transmission among PWID.
• Data Sources:
  • Published literature, government agencies, and NGOs were used to obtain data on HIV prevalence, drug use, and programme costs.
• Economic Analysis:
  • Direct healthcare costs and savings were calculated.
  • The analysis considered three time periods: 2006–2013, 2013–2023, and 2006–2050.
  • A 3% discount rate was applied to future costs and benefits.
  • The study evaluated both combined and individual programmes (NSP and MMT).

Conclusion

• The harm reduction programme in Malaysia, particularly the combination of NSP and MMT, has been effective in reducing new HIV infections and improving the quality of life for PWID.
• The programme has demonstrated cost-effectiveness and significant ROI, making it a valuable investment for the government.
• The study underscores the importance of continued political commitment and multisectoral collaboration to sustain and enhance the impact of harm reduction efforts in Malaysia.