Cost-effectiveness findings for naloxone revealed

Researchers have found that naloxone distribution to heroin users could reduce the number of deaths from overdose while being cost-effective.

The probabilistic analysis of naloxone use in hypothetical 21-year-old novice US heroin users and more experienced users revealed that naloxone distribution was cost-effective in all deterministic and probabilistic sensitivity and scenario analyses.

Moreover, it was cost saving when it resulted in fewer overdoses or emergency medical service activations.

Phillip Coffin (San Francisco Department of Public Health, California, USA) and Sean Sullivan (University of Washington, Seattle, USA) note that in a worst-case scenario where overdose was rarely witnessed and naloxone was rarely used, minimally effective, and expensive, the incremental cost-effectiveness ratio (ICER) was US$ 14,000 (€ 10,618).

If national drug-related expenditures were applied to heroin users, the ICER was $ 2429 (€ 1842).

In a related editorial, Wilson Compton (National Institute on Drug Abuse, Bethesda, Maryland, USA) and co-authors say that Coffin and Sullivan's study "represents a significant step in the evolution of the science in this area."

"Despite its [naloxone's] potential to safely, rapidly, and completely reverse an opioid overdose, the public health impact of this medication has not yet reached its full potential," they write in the Annals of Internal Medicine.

Coffin and Sullivan found that 6.1% of overdose deaths in the probabilistic analysis were prevented with naloxone distribution, and one death was prevented for every 227 naloxone kits distributed.

Although naloxone distribution increased healthcare costs by $ 53 (€ 40) per person, it increased the number of quality-adjusted life-years (QALYs) by 0.119 for an ICER OF $ 438 (€ 332).

"In summary, this analysis of naloxone distribution to heroin users for lay overdose reversal suggests that the intervention would increase QALYs and be highly cost-effective, even under markedly conservative assumptions," write the authors.

"Controlled trials that more precisely define the utilization and relative benefit of lay naloxone distribution would help refine future modeling."

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