New Zealand Needle and Syringe Exchange programme review. Final report.

New Zealand's Needle and Syringe Exchange Programme (NSEP) was reviewed to assess whether the NSEP was working in the most effective and efficient way possible within available resources. Information was collected through a literature review, consultations with NSEP stakeholders and key agencies, a survey of IDUs, and a call for public submissions. Methods and data used in Return On Investment In Needle & Syringe Programs In Australia (Health Outcomes International, the National Centre for HIV Epidemiology and Clinical Research, and Drummond M, 2002) were adapted to enable projections of the numbers of people living with HIV and HCV infections and produce cost/benefit estimates. Fewer than 5% of respondents reported frequent difficulty in obtaining injecting equipment, and over 90% perceived little or no difficulty due to distance from NSEP outlets. Needle-sharing among New Zealand IDUs has declined substantially since the mid-1990s. Had the NSEP not been introduced, by end 2001 an estimated extra 1,454 New Zealanders would have been living with hepatitis C, another 1,031 with HIV/AIDS, and an extra 20 would have died following an HIV infection. The net financial benefit of New Zealand's NSEP, based on HIV and HCV treatment costs avoided between 1988 and 2001, was NZ$25,033,928. Every $1 spent on the NSEP saved an estimated $3.35 in healthcare costs during the period of investment. Projecting forward until putative extra New Zealanders infected between 1988 and 2001 were estimated to have died produced a cumulative net benefit of NZ$202,274,686; using this approach, every $1 spent on the NSEP yielded $20.00 in lifetime treatment costs avoided. Conclusion: New Zealand's NSEP is effective in reaching IDUs and reducing harm (HIV and HCV infections) among them, and does so very efficiently