Distributing Naloxone to People Who Use Heroin for Lay Treatment of Overdose is Cost-Effective

Research shows that laypersons can safely and effectively deliver naloxone to reverse witnessed heroin overdoses. In this study, researchers used a decision analytic computer model to estimate the cost-effectiveness (CE) of distributing naloxone to people with heroin use. The model compared a strategy of distributing naloxone to 20% of people who use heroin with a strategy of no distribution and was designed to bias against the naloxone strategy. Values and ranges for the model parameters (proportions, transition rates, costs, utilities) were extracted from published literature. The model outputs were costs, quality-adjusted life-years (QALYs), and incremental CE ratios (costs per QALY).

• In the base case analysis, the naloxone distribution strategy:
  • prevented 6% of overdose deaths.
  • required the distribution of 227 naloxone kits to prevent 1 overdose death.
  • had an incremental CE ratio of $438 per QALY gained.
• In sensitivity analyses, the naloxone distribution strategy remained cost-effective (most incremental CE ratios less than $1000 per QALY gained) over a wide range of scenarios and parameter values. Even the worst-case scenario (overdoses rarely witnessed and naloxone more expensive, less efficacious, and rarely carried) had an incremental CE ratio of $14,000 per QALY.

Comments:

This well-done analysis suggests that naloxone distribution is highly cost-effective when compared with no distribution. The incremental CE ratios are far lower than those for many common healthcare practices and well within thresholds considered cost-effective by policymakers. Although controlled data were not available for some parameters of the model, it seems robust and lends support to the distribution of naloxone to people who abuse heroin and prescription opioids.

Kevin L. Kraemer, MD, MSc

Reference:

Coffin PO, Sullivan SD. Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal. Ann Intern Med. 2013;158(1):1–9.