Community Distribution of Naloxone: A Systematic Review of Economic Evaluations

Cherrier, Nelda; Kearon, Joanne; Tetreault, Robin; Garasia, Sophiya; Guindon, G. Emmanuel

doi:10.1007/s41669-021-00309-z

Cited by 16 publications

(9 citation statements)

References 22 publications

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“…An analysis from the Canadian Pharmacists Association on other pharmacy services such as smoking cessation, advanced medication review for heart disease, and pneumococcal vaccination revealed that Canada-wide implementation of these services could yield cost savings of CAD 2.5 billion to CAD 25.7 billion over the next 20 years depending on program uptake [33]. Research has also showcased that community distribution of naloxone, which is publicly funded and is available through community pharmacies in Canada, not only saves lives but is also a cost-effective strategy for combating the opioid crisis [39,40]. However, an appropriately powered cost-benefit analysis has yet to be conducted on pharmacist pain management interventions, and future studies are required to demonstrate costs associated with implementation and any cost savings for the healthcare system [40].…”

Section: Future Studiesmentioning

confidence: 99%

“…Research has also showcased that community distribution of naloxone, which is publicly funded and is available through community pharmacies in Canada, not only saves lives but is also a cost-effective strategy for combating the opioid crisis [39,40]. However, an appropriately powered cost-benefit analysis has yet to be conducted on pharmacist pain management interventions, and future studies are required to demonstrate costs associated with implementation and any cost savings for the healthcare system [40].…”

Section: Future Studiesmentioning

confidence: 99%

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Addressing the Opioid Crisis—The Need for a Pain Management Intervention in Community Pharmacies in Canada: A Narrative Review

Cid

2023

Pharmacy

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Background: The opioid crisis is a public health concern in Canada with a continued rise in deaths and presents a significant economic impact on the healthcare system. There is a need to develop and implement strategies for decreasing the risk of opioid overdoses and other opioid-related harms resulting from the use of prescription opioids. Pharmacists, as medication experts and educators, and as one of the most accessible frontline healthcare providers, are well positioned to provide effective opioid stewardship through a pain management program focused on improving pain management for patients, supporting appropriate prescribing and dispensing of opioids, and supporting safe and appropriate use of opioids to minimize potential opioid misuse, abuse, and harm. Methods: A literature search was conducted in PubMed, Embase and grey literature to determine the characteristics of an effective community pharmacy-based pain management program, including the facilitators and barriers to be considered. Discussion: An effective pain management program should be multicomponent, address other co-morbid conditions in addition to pain, and contain a continuing education component for pharmacists. Solutions to implementation barriers, including pharmacy workflow; addressing attitudes beliefs, and stigma; and pharmacy remuneration, as well as leveraging the expansion of scope from the Controlled Drugs and Substances Act exemption to facilitate implementation, should be considered. Conclusions: Future work should include the development, implementation, and evaluation of a multicomponent, evidence-based intervention strategy in Canadian community pharmacies to demonstrate the impact pharmacists can have on the management of chronic pain and as one potential solution to helping curb the opioid crisis. Future studies should measure associated costs for such a program and any resulting cost-savings to the healthcare system.

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Section: Future Studiesmentioning

confidence: 99%

Section: Future Studiesmentioning

confidence: 99%

Addressing the Opioid Crisis—The Need for a Pain Management Intervention in Community Pharmacies in Canada: A Narrative Review

Cid

2023

Pharmacy

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“…A 2022 systematic review of economic evaluations involving community naloxone included 9 articles from the United States, which all concluded that community distribution of naloxone was cost-effective, with an incremental cost-utility ratio range of $58,738 to $111,000 US (2020) per quality-adjusted life year (QALY) gained. 10 The review included only 1 study that examined pharmacy-based naloxone kit distribution. 11 This study determined that one-time distribution of IN naloxone to high-risk prescription opioid patients prevented 14 additional overdose deaths per 100,000 persons, with an incremental cost-effectiveness ratio (ICER) of $56,699 US per QALY.…”

Section: Introductionmentioning

confidence: 99%

“… 11 There is a need to conduct a cost-effectiveness study of pharmacy-based naloxone in the Canadian context, as most studies have been conducted in the United States, which does not have a public health care funding model, and the expiry date of naloxone was recently extended to 3 years, which has not been included in other economic evaluations. 10 - 12 The objective of this study was to determine the cost-effectiveness of pharmacy-based IM and IN naloxone distribution to consumers of prescription and illicit opioids, as well as opioid-agonist therapy (OAT) and nonopioid consumers (family or bystanders).…”

Section: Introductionmentioning

confidence: 99%

An economic evaluation of community pharmacy–dispensed naloxone in Canada

Cid,

Mahajan,

Wong

et al. 2024

Can Pharm J

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Aims: To determine the cost-effectiveness of pharmacy-based intranasal (IN) and intramuscular (IM) naloxone distribution in Canada. Methods: We developed a state-transition model for pharmacy-based naloxone distribution, every 3 years, to illicit, prescription, opioid-agonist therapy and nonopioid use populations compared to no naloxone distribution. We used a monthly cycle length, lifetime horizon and a Canadian provincial Ministry of Health perspective. Transition probabilities, cost and utility data were retrieved from the literature. Costs (2020) and quality-adjusted life years (QALY) were discounted 1.5% annually. Microsimulation, 1-way and probabilistic sensitivity analyses were conducted. Results: Distribution of naloxone to all Canadians compared to no distribution prevented 151 additional overdose deaths per 10,000 persons, with an incremental cost-effectiveness ratio (ICER) of $50,984 per QALY for IM naloxone and an ICER of $126,060 per QALY for IN naloxone. Distribution of any naloxone to only illicit opioid users was the most cost-effective. One-way sensitivity analysis showed that survival rates for illicit opioid users were most influenced by the availability of either emergency medical services or naloxone. Conclusion: Distribution of IM and IN naloxone to all Canadians every 3 years is likely cost-effective at a willingness-to-pay threshold of $140,000 Canadian dollars/QALY (~3 × gross domestic product from the World Health Organization). Distribution to people who use illicit opioids was most cost-effective and prevented the most deaths. This is important, as more overdose deaths could be prevented through nationwide public funding of IN naloxone kits through pharmacies, since individuals report a preference for IN naloxone and these formulations are easier to use, save lives and are cost-effective. Can Pharm J (Ott) 2024;157:xx-xx.

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“…While prior research has demonstrated the effectiveness of community-based opioid education and naloxone distribution (OEND) programs to reduce opioid overdose in some settings ( Walley et al, 2013 ), less is known about the population effectiveness of pharmacy-distributed naloxone, especially in areas where longstanding OEND programs exist ( Oliva et al, 2016 ). Systematic reviews of naloxone distribution that include non-US jurisdictions are similar, in which effectiveness of general distribution is greatest for populations most at risk ( Cherrier et al, 2022 ), while studies of pharmacy distribution specifically are less common and lack large implementation studies that could demonstrate effectiveness ( Nielsen and Van Hout, 2016 ). Pharmacy distribution of naloxone is supported by standing orders (e.g., dispensed to anyone who requests it, without need of a prescription) and other local policies, and appears to be a successful mechanism to increase the naloxone supply in the community ( Abouk et al, 2019 ; Murphy et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%