Abstract
Objective:
To evaluate the cost-effectiveness of distributing naloxone to illicit opioid users for lay overdose reversal in Russian cities.
Method:
This study adapted an integrated Markov and decision analytic model to Russian cities. The model took a lifetime, societal perspective, relied on published literature, and was calibrated to epidemiologic findings.
Results:
For each 20% of heroin users reached with naloxone distribution, the model predicted a 13.4% reduction in overdose deaths in the first 5 years and 7.6% over a lifetime; on probabilistic analysis, one death would be prevented for every 89 naloxone kits distributed (95% CI = 32–260). Naloxone distribution was cost-effective in all deterministic and probabilistic sensitivity analyses and cost-saving if resulting in a reduction in overdose events. Naloxone distribution increased costs by US$13 (95% CI = US$3–US$32) and QALYs by 0.137 (95% CI = 0.022–0.389) for an incremental cost of US$94 per QALY gained (95% CI = US$40–US$325). In a worst-case scenario where overdose was rarely witnessed and naloxone was rarely used, minimally effective, and expensive, the incremental cost was US$1987 per QALY gained. If national expenditures on drug-related HIV, tuberculosis, and criminal justice were applied to heroin users, the incremental cost was US$928 per QALY gained.
Conclusions:
Naloxone distribution to heroin users for lay overdose reversal is highly likely to reduce overdose deaths in target communities and is robustly cost-effective, even within the constraints of this conservative model.
Transparency
Declaration of funding
Adaptation of this model to Russia was supported by the Open Society Foundation; the funder had no role in the design of the study or preparation of the manuscript. The authors take full responsibility for all elements of the study and manuscript.
Declaration of financial/other relationships
The authors declare no financial, employment, or other significant relevant relationships. JME Peer Reviewers on this manuscript have no relevant financial or other relationships to disclose.
Acknowledgments
The authors declare no assistance in the preparation of this article.