Naloxone distribution cost-effective way to reduce heroin overdose deaths

January 10, 2013

Distributing naloxone to heroin users may be a cost-effective way to reduce the number of overdose deaths, a new study finds.

Distributing naloxone to heroin users may be a cost-effective way to reduce the number of overdose deaths, a new study finds.

Phillip O. Coffin, MD, from the San Francisco Department of Public Health, and Sean D. Sullivan, PhD, of the Pharmaceutical Outcomes Research and Policy Program at the University of Washington, developed a computer simulation based on estimates from previous studies to assess the number of deaths and cost of distributing naloxone injection kits to 20% of U.S. heroin users and people likely to witness an overdose. The authors compared that result with a simulation of the number of deaths and cost in a population of users who did not receive kits.

Their analysis, published in the January issue of Annals of Internal Medicine, determined that naloxone distribution prevented 6% of overdose deaths or one death for every 227 kits distributed (95% CI, 71 to 716). Although distribution increased costs by $53 (CI, $3 to $156), they found that it increased quality-adjusted life-years by 0.119 (CI, 0.017 to 0.378) for an incremental cost-effectiveness ratio (ICER) of $438 (CI, $48 to $1706).

The results lead the authors to conclude that lay naloxone administration would likely reduce overdose deaths even under very conservative assumptions.

"In a 'worst-case scenario' where overdose was rarely witnessed and naloxone was rarely used, minimally effective, and expensive, the ICER was $14,000," the authors found. "If national drug-related expenditures were applied to heroin users, the ICER was $2,429."

In an accompanying editorial, doctors associated with the National Institute on Drug Abuse in Bethesda, Md., and FDA in Silver Springs, Md., noted that the only FDA-approved formulation of the drug is injectable. The authors say intranasal devices and auto-injectors are promising alternatives, and a non-prescription formulation would encourage broader use; however all of these options require more research.

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