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Ann Intern Med. 2013 Jan 1;158(1):1-9. doi: 10.7326/0003-4819-158-1-201301010-00003.

Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal.

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  • 1San Francisco Department of Public Health, San Francisco, CA 94102, USA.

Abstract

BACKGROUND:

Opioid overdose is a leading cause of accidental death in the United States.

OBJECTIVE:

To estimate the cost-effectiveness of distributing naloxone, an opioid antagonist, to heroin users for use at witnessed overdoses.

DESIGN:

Integrated Markov and decision analytic model using deterministic and probabilistic analyses and incorporating recurrent overdoses and a secondary analysis assuming heroin users are a net cost to society.

DATA SOURCES:

Published literature calibrated to epidemiologic data.

TARGET POPULATION:

Hypothetical 21-year-old novice U.S. heroin user and more experienced users with scenario analyses.

TIME HORIZON:

Lifetime.

PERSPECTIVE:

Societal.

INTERVENTION:

Naloxone distribution for lay administration.

OUTCOME MEASURES:

Overdose deaths prevented and incremental cost-effectiveness ratio (ICER).

RESULTS OF BASE-CASE ANALYSIS:

In the probabilistic analysis, 6% of overdose deaths were prevented with naloxone distribution; 1 death was prevented for every 227 naloxone kits distributed (95% CI, 71 to 716). Naloxone distribution increased costs by $53 (CI, $3 to $156) and quality-adjusted life-years by 0.119 (CI, 0.017 to 0.378) for an ICER of $438 (CI, $48 to $1706).

RESULTS OF SENSITIVITY ANALYSIS:

Naloxone distribution was cost-effective in all deterministic and probabilistic sensitivity and scenario analyses, and it was cost-saving if it resulted in fewer overdoses or emergency medical service activations. In a "worst-case scenario" where overdose was rarely witnessed and naloxone was rarely used, minimally effective, and expensive, the ICER was $14 000. If national drug-related expenditures were applied to heroin users, the ICER was $2429.

LIMITATION:

Limited sources of controlled data resulted in wide CIs.

CONCLUSION:

Naloxone distribution to heroin users is likely to reduce overdose deaths and is cost-effective, even under markedly conservative assumptions.

PRIMARY FUNDING SOURCE:

National Institute of Allergy and Infectious Diseases.

Comment in

PMID:
23277895
[PubMed - indexed for MEDLINE]
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