Projected Health and Economic Outcomes in People Who Inject Drugs in the United States, 2025-2034: A Modeling Study.
6 affiliations
- 1Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
- 2Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.
- 3Harvard Medical School, Boston, Massachusetts, USA.
- 4Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
- 5Mass General Brigham, Somerville, Massachusetts, USA.
- 6Center for Health Technology Assessment, Mass General Brigham, Boston, Massachusetts, USA.
Abstract
Background
People who inject drugs (PWID) face complications from injection drug use (IDU), including drug overdoses and infections (HIV, hepatitis C virus [HCV], and other serious injection-related infections). Decision makers need estimates of clinical outcomes and costs to plan health service programs and allocate resources.Method
We developed a microsimulation model, the Multimorbidity model to Reduce Infections Associated with Drug use (MYRIAD), with inputs derived from published data. We projected key clinical outcomes and costs in PWID in the United States from 2025 to 2034: new HIV and HCV cases, hospitalizations for severe injection-related infections (eg, endocarditis), and deaths from drug overdose and injection-related infections. We varied multiple parameters in deterministic sensitivity analyses and varied overdose death risk in scenario analyses.Results
For 3.3 million PWID over 10 years, we estimate that 29 715 new HIV infections, 218 186 new HCV infections or reinfections, and 1 714 773 hospitalizations from severe injection-related infections will occur. We project 487 249 deaths from IDU: 348 650 from drug overdose, 37 658 from severe injection-related infections, 90 486 from HCV, and 10 455 from HIV. Healthcare costs from IDU are projected to exceed $565 billion, with $431 billion from drug use and $135 billion from injection-related infections.Conclusions
The United States will face increasing IDU-related deaths and healthcare costs over the next decade with current levels of care. Although deaths are driven primarily by drug overdose, many are from injection-related infections. Interventions that concurrently prevent and treat drug overdose and injection-related infections are urgently needed to curb morbidity and mortality among PWID.
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BibTeX
@article{chiosi2026projected,
title = {{Projected Health and Economic Outcomes in People Who Inject Drugs in the United States, 2025-2034: A Modeling Study.}},
author = {John J Chiosi and John Giardina and Sarah E Wakeman and Kenneth A Freedberg and Jagpreet Chhatwal and Andrea L Ciaranello},
journal = {Open forum infectious diseases},
year = {2026},
month = oct,
doi = {10.1093/ofid/ofag675},
url = {https://europepmc.org/article/MED/42921482},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Projected Health and Economic Outcomes in People Who Inject Drugs in the United States, 2025-2034: A Modeling Study.
AU - John J Chiosi
AU - John Giardina
AU - Sarah E Wakeman
AU - Kenneth A Freedberg
AU - Jagpreet Chhatwal
AU - Andrea L Ciaranello
PY - 2026
DA - 2026/10/09
JO - Open forum infectious diseases
DO - 10.1093/ofid/ofag675
UR - https://europepmc.org/article/MED/42921482
AB - Background People who inject drugs (PWID) face complications from injection drug use (IDU), including drug overdoses and infections (HIV, hepatitis C virus [HCV], and other serious injection-related infections). Decision makers need estimates of clinical outcomes and costs to plan health service programs and allocate resources.Method We developed a microsimulation model, the Multimorbidity model to Reduce Infections Associated with Drug use (MYRIAD), with inputs derived from published data. We projected key clinical outcomes and costs in PWID in the United States from 2025 to 2034: new HIV and HCV cases, hospitalizations for severe injection-related infections (eg, endocarditis), and deaths from drug overdose and injection-related infections. We varied multiple parameters in deterministic sensitivity analyses and varied overdose death risk in scenario analyses.Results For 3.3 million PWID over 10 years, we estimate that 29 715 new HIV infections, 218 186 new HCV infections or reinfections, and 1 714 773 hospitalizations from severe injection-related infections will occur. We project 487 249 deaths from IDU: 348 650 from drug overdose, 37 658 from severe injection-related infections, 90 486 from HCV, and 10 455 from HIV. Healthcare costs from IDU are projected to exceed $565 billion, with $431 billion from drug use and $135 billion from injection-related infections.Conclusions The United States will face increasing IDU-related deaths and healthcare costs over the next decade with current levels of care. Although deaths are driven primarily by drug overdose, many are from injection-related infections. Interventions that concurrently prevent and treat drug overdose and injection-related infections are urgently needed to curb morbidity and mortality among PWID.
SN - 2328-8957
ER -