Detachable low dead space syringes for the prevention of hepatitis C among people who inject drugs in Bristol, UK: an economic evaluation

Abstract

Background and Aims Traditional detachable syringes used by people who inject drugs (PWID) retain larger volumes of blood when the plunger is depressed than syringes with fixed needles—referred to as high (HDSS) and low dead space syringes (LDSS), respectively. Evidence suggests that using HDSS may result in greater hepatitis C virus (HCV) transmission risk than LDSS. We evaluated the cost‐effectiveness of an intervention to introduce detachable LDSS in a needle and syringe programme (NSP). Design HCV transmission and disease progression model with cost‐effectiveness analysis using a health‐care perspective. Detachable LDSS are associated with increased costs (£0.008) per syringe, yearly staff training costs (£536) and an estimated decreased risk (by 47.5%) of HCV transmission compared with HDSS. The intervention was modelled for 10 years, with costs and health benefits (quality‐adjusted life‐years: QALYs) tracked over 50 years. Setting Bristol, UK. Participants and Cases PWID attending NSP. Intervention and comparator Gradual replacement of HDSS at NSP, with 8, 58 and 95% of HDSS being replaced by detachable LDSS in 2016, 2017 and 2018, respectively. Comparator was continuing use of HDSS. Measurements Net monetary benefit. Benefits were measured in QALYs. Findings Introducing detachable LDSS was associated with a small increase in intervention costs (£21 717) compared with not introducing detachable LDSS, but considerable savings in HCV‐related treatment and care costs (£4 138 118). Overall cost savings were £4 116 401 over 50 years and QALY gains were 1000, with an estimated 30% reduction in new infections over the 10‐year intervention period. In all sensitivity analyses, detachable LDSS resulted in cost savings and additional QALYs. Threshold analyses suggested that detachable LDSS would need to reduce HCV transmission risk of HDSS by 0.26% to be cost‐saving and 0.04% to be cost‐effective. Conclusions Replacing high dead space syringes with detachable low dead space syringes in needle and syringe programmes in the United Kingdom is likely to be a cost‐saving approach for reducing hepatitis C virus transmission.

Response to Commentary on Hancock et al. (2020): Low dead space syringes are just one component of an integrated package of care needed to tackle HCV and social exclusion among people who inject drugs

“…We read with interest Platt et al's commentary [1] on our economic analysis [2] and agree with many of the points raised, particularly the urgent need to 'avert the growing health crisis faced by [people who inject drugs] PWID in the United Kingdom'. We agree that the provision of detachable low dead space syringes (LDSS) is one of several diverse strategies needed to address hepatitis C virus (HCV) transmission and, more broadly, to reduce social exclusion and health and social inequalities among PWID.…”

Effectiveness of the air-filled technique to reduce the dead space in syringes and needles during ChAdox1-n CoV vaccine administration

“…If the medical personnel and recipients receiving injection have a thick subcutaneous layer, a 1.5-length 25G needle should be used instead. 5. the needle should be pulled out from the vaccine recipient and removed in the needle clipping devices without using the luer lock.…”

“…The amount of overfilled vaccine is the same in every brand for multiple dose vials, including Pfizer, which has sufficient vaccines for six people. Therefore, in many countries that have reserved COVID-19 vaccines, the multiple dose type is assigned to use an low dead space (LDS) syringes and needles to reduce the wasted volume that remains in the tip of the syringes and needles [5]. However, the LDS and needle cost is 4 to 10 times more than a 1-ml syringe and 25G needle (1 to 1.5-inch length ).Therefore the latter syringes and needle needles are commonly used.…”

The Effectiveness of Low Dead Space Syringes for Reducing the Risk of Hepatitis C Virus Acquisition Among People Who Inject Drugs: Findings From a National Survey in England, Wales, and Northern Ireland

“…This preference for syringes with detachable needles led to the development of detachable LDSS, with numerous settings expanding their distribution [ 12 ] to minimize the risks associated with using syringes with detachable needles. Our recent UK cost-effectiveness analysis suggested that this strategy could be cost-saving [ 13 ].…”