Cost-effectiveness analysis of alternative naloxone distribution strategies: First responder and lay distribution in the United States

Townsend, Tarlise; Blostein, Freida; Doan, Tran T.; Madson-Olson, Samantha; Galecki, Paige; Hutton, David

doi:10.1016/j.drugpo.2019.07.031

Cited by 54 publications

(44 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Overdose education and naloxone distribution to people with OUD, family, friends, first responders, and other community members is a potent intervention that reduces opioid overdose fatalities. 14,[20][21][22][23] Distribution of greater than just 100 kits per 100,000 population, for example, has been associated with a 46% reduction in community opioid overdose death. 14 At the state level, mandating co-prescribing of naloxone to patients at increased risk of overdose significantly increases naloxone prescribing.…”

Section: Provide Intranasal Naloxonementioning

confidence: 99%

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings

et al. 2021

View full text Add to dashboard Cite

Opioid use disorder (OUD) is increasingly recognized as a chronic, relapsing brain disease whose treatment should be integrated into primary care settings alongside other chronic conditions. However, abstinence from all non-prescribed substance use continues to be prioritized as the only desired goal in many outpatient, primary care–based treatment programs. This presents a barrier to engagement for patients who continue to use substances and who may be at high risk for complications of ongoing substance use such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), superficial and deep tissue infections, and overdose. Harm reduction aims to reduce the negative consequences of substance use and offers an alternative to abstinence as a singular goal. Incorporating harm reduction principles into primary care treatment settings can support programs in engaging patients with ongoing substance use and facilitate the delivery of evidence-based screening and prevention services. The objective of this narrative review is to describe strategies for the integration of evidence-based harm reduction principles and interventions into outpatient, primary care–based OUD treatment settings. We will offer specific tools for providers and programs including strategies to support safer injection practices, assess the risks and benefits of continuing medications for opioid use disorder in the setting of ongoing substance use, promote a non-stigmatizing program culture, and address the needs of special populations with ongoing substance use including adolescents, parents, and families. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06904-4.

show abstract

Section: Provide Intranasal Naloxonementioning

confidence: 99%

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Interventions and accompanying comparators of interest included one prevention strategy (abuse-deterrent opioids), 35 treatment strategies (opioid agonist, partial agonist, or antagonist maintenance therapies), 30,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] and strategies involving naloxone distribution (distribution to laypeople; emergency medical services (EMS), police and fire workers; and secondary schools). [51][52][53][54][55] One study considered multiple sets of strategy combinations. 56 The focus of economic evaluations has shifted over time as the incidence of overdose has escalated.…”

Section: Intervention and Comparatormentioning

confidence: 99%

“…Analyses of opioid agonist or partial agonist therapies (methadone and buprenorphine maintenance) were the predominant strategy evaluated between 1999 and 2005, and these continue to be relevant through the present day. Evaluations of naloxone distribution strategies increased beginning in 2013, [51][52][53][54][55][56] coinciding with the rapid rise in overdose deaths and increasing fentanyl contamination of the heroin supply.…”

Section: Intervention and Comparatormentioning

confidence: 99%

Economic Evaluation in Opioid Modeling: Systematic Review

et al. 2021

View full text Add to dashboard Cite

The rapid increase in opioid overdose and opioid use disorder (OUD) over the past 20 years is a complex problem associated with significant economic costs for healthcare systems and society. Simulation models have been developed to capture and identify ways to manage this complexity and to evaluate the potential costs of different strategies to reduce overdoses and OUD. A review of simulation-based economic evaluations is warranted to fully characterize this set of literature.Methods: A systematic review of simulation-based economic evaluation (SBEE) studies in opioid research was initiated by searches in PubMed, EMBASE, and EbscoHOST. Extraction of a predefined set of items and a quality assessment were performed for each study. Results:The screening process resulted in 23 SBEE studies ranging by year of publication from 1999 to 2019. Methodological quality of the cost analyses was moderately high. The most frequently evaluated strategies were methadone and buprenorphine maintenance treatments; the only harm reduction strategy explored was naloxone distribution. These strategies were consistently found to be cost-effective, especially naloxone distribution and methadone maintenance. Prevention strategies were limited to abuse-deterrent opioid formulations. Less than half (39%) of analyses adopted a societal perspective in their estimation of costs and effects from an opioid-related intervention. Prevention strategies and studies' accounting for patient and physician preference, changing costs, or result stratification were largely ignored in these SBEEs. Conclusion:The review shows consistently favorable cost analysis findings for naloxone distribution strategies and opioid agonist treatments and identifies major gaps for future research.

show abstract

“…For instance, the cost-effectiveness of MOUD has an established evidence base across a variety of settings and populations, particularly for methadone maintenance therapy and buprenorphine ( Barocas et al, 2019 ; Busch et al, 2017 ; Dunlap et al, 2018 ; Gisev et al, 2015 ; Krebs et al, 2018 ; Murphy et al, 2019 ; Murphy and Polsky, 2016 ). Additionally, programs providing naloxone to high-risk individuals and first responders for reducing opioid overdose mortality have also been found cost-effective ( Coffin and Sullivan, 2013 ; Townsend et al, 2020 ). Notably, there is a lack of literature on the cost-effectiveness of safer opioid prescribing and dispensing programs.…”

Section: Introductionmentioning

confidence: 99%

Health economic design for cost, cost-effectiveness and simulation analyses in the HEALing Communities Study

Aldridge

Barbosa

Barocas

et al. 2020

Drug and Alcohol Dependence

View full text Add to dashboard Cite

Highlights The HEALing Communities Study (HCS) is designed to implement and evaluate the Communities That HEAL (CTH) intervention to reduce opioid overdose deaths. The HCS includes a health economics study. Costs of CTH will be estimated for multiple perspectives. The health economics study includes cost-effectiveness analyses and simulation modeling.

show abstract

Cost-effectiveness analysis of alternative naloxone distribution strategies: First responder and lay distribution in the United States

Cited by 54 publications

References 41 publications

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings

Economic Evaluation in Opioid Modeling: Systematic Review

Health economic design for cost, cost-effectiveness and simulation analyses in the HEALing Communities Study

Contact Info

Product

Resources

About