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.
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.