• Phillip O Coffin and Sean D Sullivan.
• San Francisco Department of Public Health, San Francisco, CA 94102, USA.
• Ann. Intern. Med. 2013 Jan 1; 158 (1): 1-9.

BackgroundOpioid overdose is a leading cause of accidental death in the United States.ObjectiveTo estimate the cost-effectiveness of distributing naloxone, an opioid antagonist, to heroin users for use at witnessed overdoses.DesignIntegrated 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 SourcesPublished literature calibrated to epidemiologic data.Target PopulationHypothetical 21-year-old novice U.S. heroin user and more experienced users with scenario analyses.Time HorizonLifetime.PerspectiveSocietal.InterventionNaloxone distribution for lay administration.Outcome MeasuresOverdose deaths prevented and incremental cost-effectiveness ratio (ICER).Results Of Base Case AnalysisIn 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 AnalysisNaloxone 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.LimitationLimited sources of controlled data resulted in wide CIs.ConclusionNaloxone distribution to heroin users is likely to reduce overdose deaths and is cost-effective, even under markedly conservative assumptions.Primary Funding SourceNational Institute of Allergy and Infectious Diseases.

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