Cost-Effectiveness of Intranasal Naloxone Distribution to High-Risk Prescription Opioid Users

Abstract

Objectives: To determine the cost-effectiveness of pharmacy-based intranasal naloxone distribution to high-risk prescription opioid (RxO) users. Methods:We developed a Markov model with an attached tree for pharmacy-based naloxone distribution to high-risk RxO users using 2 approaches: one-time and biannual follow-up distribution. The Markov structure had 6 health states: high-risk RxO use, low-risk RxO use, no RxO use, illicit opioid use, no illicit opioid use, and death. The tree modeled the probability of an overdose happening, the overdose being witnessed, naloxone being available, and the overdose resulting in death. Highrisk RxO users were defined as individuals with prescription opioid doses greater than or equal to 90 morphine milligram equivalents (MME) per day. We used a monthly cycle length, lifetime horizon, and US healthcare perspective. Costs (2018) and quality-adjusted life-years (QALYs) were discounted 3% annually. Microsimulation was performed with 100 000 individual trials. Deterministic and probabilistic sensitivity analyses were conducted.Results: One-time distribution of naloxone prevented 14 additional overdose deaths per 100 000 persons, with an incremental cost-effectiveness ratio (ICER) of $56 699 per QALY. Biannual follow-up distribution led to 107 additional lives being saved with an ICER of $84 799 per QALY compared with one-time distribution. Probabilistic sensitivity analyses showed that a biannual follow-up approach would be cost-effective 50% of the time at a willingness-to-pay (WTP) threshold of $100 000 per QALY. Naloxone effectiveness and proportion of overdoses witnessed were the 2 most influential parameters for biannual distribution. Conclusion:Both one-time and biannual follow-up naloxone distribution in community pharmacies would modestly reduce opioid overdose deaths and be cost-effective at a WTP of $100 000 per QALY.

Investigating Community Pharmacy Take Home Naloxone Dispensing during COVID-19: The Impact of One Public Health Crisis on Another

“…Even before the pandemic, opioid overdose deaths were increasing significantly [5]. Studies have also been conducted to show that the provision of naloxone kits to opioid users is cost effective [30][31][32]. As the number of opioid overdoses appears to be increasing with the pandemic, it is imperative that pharmacy professionals be trained on the importance of being proactive in their approach to offering patients naloxone kits.…”

Community Distribution of Naloxone: A Systematic Review of Economic Evaluations

“…Results of the study by Acharya et al [26], set in the USA, showed that intervention modestly reduced overdose deaths, with an ICUR of $US56,699-76,929 (year 2018 values; $US58,400-79,237 in 2020) per QALY gained. Thus, naloxone distribution was worthwhile, assuming a WTP threshold of $US100,000 (year 2018 values; $US103,083 in 2020) [26].…”

“…Results of the study by Acharya et al [26], set in the USA, showed that intervention modestly reduced overdose deaths, with an ICUR of $US56,699-76,929 (year 2018 values; $US58,400-79,237 in 2020) per QALY gained. Thus, naloxone distribution was worthwhile, assuming a WTP threshold of $US100,000 (year 2018 values; $US103,083 in 2020) [26]. Both deterministic and probabilistic sensitivity analyses were performed, which considered the price of naloxone, naloxone effectiveness, the proportion of overdoses witnessed, the probability of EMS intervention, overdose risk based on the specific opioid, and overdose survival rates [26].…”

“…Thus, naloxone distribution was worthwhile, assuming a WTP threshold of $US100,000 (year 2018 values; $US103,083 in 2020) [26]. Both deterministic and probabilistic sensitivity analyses were performed, which considered the price of naloxone, naloxone effectiveness, the proportion of overdoses witnessed, the probability of EMS intervention, overdose risk based on the specific opioid, and overdose survival rates [26]. In the deterministic sensitivity analysis, naloxone effectiveness and the proportion of overdoses witnessed had the largest impact on biannual distribution but did not have a large enough impact to change the conclusion [26].…”

“…Both deterministic and probabilistic sensitivity analyses were performed, which considered the price of naloxone, naloxone effectiveness, the proportion of overdoses witnessed, the probability of EMS intervention, overdose risk based on the specific opioid, and overdose survival rates [26]. In the deterministic sensitivity analysis, naloxone effectiveness and the proportion of overdoses witnessed had the largest impact on biannual distribution but did not have a large enough impact to change the conclusion [26]. This study quality was assessed as moderate because of the lack of clear reporting of the viewpoints of the analysis, the rationale for choosing the alternative program or intervention, the justification of the form of economic evaluation, the quantities of resources, and price data.…”