title: Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  Published literature calibrated to epidemiologic data.
  
  
  METHODS
  Hypothetical 21-year-old novice U.S. heroin user and more experienced users with scenario analyses.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Societal.
  
  
  METHODS
  Naloxone distribution for lay administration.
  
  
  METHODS
  Overdose deaths prevented and incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  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
  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.
  
  
  CONCLUSIONS
  Limited sources of controlled data resulted in wide CIs.
  
  
  CONCLUSIONS
  Naloxone distribution to heroin users is likely to reduce overdose deaths and is cost-effective, even under markedly conservative assumptions.
  
  
  BACKGROUND
  National Institute of Allergy and Infectious Diseases.
authors.affiliation: San Francisco Department of Public Health, San Francisco, CA 94102, USA.
authors.forename: Phillip O
authors.initials: PO
authors.lastname: Coffin
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D062787:Drug Overdose / Q000517:prevention & control; D003932:Heroin / Q000506:poisoning*; D006556:Heroin Dependence / Q000188:drug therapy / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D008390:Markov Chains; D009270:Naloxone / Q000191:economics* / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000191:economics* / Q000627:therapeutic use*; D014481:United States; D055815:Young Adult
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone; D003932:Heroin