Cost-effectiveness of take-home naloxone for the prevention of fatalities from heroin overdose in the UK
Langham S, Kenworthy JJ, Grieve R, Dunlop W. Cost-effectiveness of take-home naloxone for the prevention of fatalities from heroin overdose in the UK. Value Health 2016:19(7):A525–6
Abstract
Objectives: Heroin overdose is a major cause of premature death. Naloxone is an opioid antagonist that is effective for the reversal of heroin overdose in emergency situations when used by nonmedical responders. Given the global call for take-home naloxone programmes to become more widely available, we assessed the cost-effectiveness of distributing naloxone to adults at risk of heroin overdose for use by nonmedical responders compared to no naloxone distribution in the UK.
Methods: A Markov model with an integrated decision tree was developed, based on the structure of a model published by Coffin and Sullivan in 2013, to estimate the costs and outcomes of distributing take-home naloxone, to adults at risk of heroin overdose. The model tracked heroin users through four health states (heroin use, discontinue heroin use, overdose or all-cause death). The overdose event and scenarios for naloxone distribution were modelled through a decision tree. Input parameters were sourced through published sources, using UK data where available. Costs and effects were evaluated over a lifetime and discounted at 3.5%. Sensitivity analyses were conducted.
Results: Half of heroin users in the model overdose over a lifetime leading to a high risk of mortality. The distribution of take-home naloxone decreased overdose deaths by around 6% and was cost-effective with cost per quality adjusted life years (QALYs) well below a £20,000 willingness to pay threshold. Exploratory analysis demonstrated additional benefits for the distribution of intranasal compared with intramuscular naloxone associated with needleless administration. The sensitivity analyses confirmed the robustness of the results.
Conclusions: The assessment indicates the distribution of take-home intramuscular naloxone to adults at risk of heroin overdose was highly cost-effective, falling well below the cost per QALY threshold set by UK decision makers. Scenario analysis suggested that intranasal naloxone was also cost-effective with potential advantages.
