Annals of internal medicine · 2013
Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal.
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Coffin Phillip O, Sullivan Sean D
Аннотация
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.
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.