Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Commentary

Evaluating Vancouver's supervised injection facility: data and dollars, symbols and ethics

Don C. Des Jarlais, Kamyar Arasteh and Holly Hagan
CMAJ November 18, 2008 179 (11) 1105-1106; DOI: https://doi.org/10.1503/cmaj.081678
Don C. Des Jarlais PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kamyar Arasteh PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Holly Hagan PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading
Submit a Response to This Article
Compose Response

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
References
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Minimum 7 characters.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'. Minimum 12 characters.
Your organization, institution's or residential address.
Statement of Competing Interests

Vertical Tabs

Jump to comment:

  • Response to Des Jarlais et al.
    Ahmed Bayoumi
    Posted on: 18 November 2008
  • Posted on: (18 November 2008)
    Response to Des Jarlais et al.
    • Ahmed Bayoumi

    Drs. Des Jarlais, Arasteh, and Hagan provide a thoughtful commentary on our article. Although we calibrated our model to epidemiological data for Vancouver, yielding an incidence rate among injection drug users of about 5 to 6 cases per 100 person-years, we recognize that these estimates are uncertain. However, an incidence rate of 1 case per 100 person-years, as suggested by Des Jarlais and Arasteh, is almost certainly too l...

    Show More

    Drs. Des Jarlais, Arasteh, and Hagan provide a thoughtful commentary on our article. Although we calibrated our model to epidemiological data for Vancouver, yielding an incidence rate among injection drug users of about 5 to 6 cases per 100 person-years, we recognize that these estimates are uncertain. However, an incidence rate of 1 case per 100 person-years, as suggested by Des Jarlais and Arasteh, is almost certainly too low for Vancouver. Caution should be exercised when extrapolating from recent VIDUS data since the low reported incidence rates are likely biased due to exhaustion of a fixed cohort.1 Recent estimates from Vancouver and Montreal suggest a persistently high incidence rate.2,3

    Nevertheless, the most salient question is not which incidence estimate is correct but rather whether the findings of our analysis would change with different assumptions. This is the reason that simulation models, including ours, are subjected to extensive sensitivity analysis. The commentary authors hypothesize a rate of 4 to 5 per 100 person-years for Vancouver if no supervised injection facility were in place. If we adjust our risk of transmitting HIV per needle-sharing event downward (to incorporate effects such as partner restriction and informed altruism) to yield an incidence rate of 4 cases per 100 person-years, our model still predicts that the supervised injection facility, under the most conservative assumptions about efficacy, would be cost-saving; at 3 cases per 100 person-years, the cost-effectiveness ratio would be $19,400 per life year gained. This latter estimate is approximately equal to the incremental cost-effectiveness of methadone maintenance therapy, a widely accepted treatment for injection drug users, and is within the range that would normally be considered cost effective.

    References
    1. Boileau C, Bruneau J, Al-Nachawati H, Lamothe F, Vincelette J. A Prognostic Model for HIV Seroconversion Among Injection Drug Users as a Tool for Stratification in Clinical Trials. JAIDS J Acquired Immune Defic Syndromes. 2005;39:489-95.
    2. Remis RS. HIV incidence among injection drug users in Vancouver. CMAJ. 2002;166:908-9.
    3. Wood E, Lloyd-Smith E, Li K, Strathdee SA, Small W, Tyndall MW, et al. Frequent Needle Exchange Use and HIV Incidence in Vancouver, Canada. Am J Med. 2007;120:172-9.

    Ahmed M. Bayoumi, Centre for Research on Inner City Health, St. Michael's Hospital, Toronto ON

    Gregory M. Zaric, Richard Ivey School of Business, University of Western Ontario, London ON

    Conflict of Interest:

    None declared

    Show Less
    Competing Interests: None declared.
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 179 (11)
CMAJ
Vol. 179, Issue 11
18 Nov 2008
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Evaluating Vancouver's supervised injection facility: data and dollars, symbols and ethics
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Evaluating Vancouver's supervised injection facility: data and dollars, symbols and ethics
Don C. Des Jarlais, Kamyar Arasteh, Holly Hagan
CMAJ Nov 2008, 179 (11) 1105-1106; DOI: 10.1503/cmaj.081678

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Evaluating Vancouver's supervised injection facility: data and dollars, symbols and ethics
Don C. Des Jarlais, Kamyar Arasteh, Holly Hagan
CMAJ Nov 2008, 179 (11) 1105-1106; DOI: 10.1503/cmaj.081678
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • REFERENCES
  • Responses
  • Metrics
  • PDF

Related Articles

  • Highlights
  • Dans ce numéro
  • The cost-effectiveness of Vancouver's supervised injection facility
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Time to dismantle systemic anti-Black racism in medicine in Canada
  • Preventing the introduction of SARS-CoV-2 into school settings
  • How should we move for health? The case for the 24-hour movement paradigm
Show more Commentary

Similar Articles

Collections

  • Topics
    • Research methods & statistics
    • Public health
    • HIV & AIDS

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire