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Cost-effectiveness analysis of alternative naloxone distribution strategies: First responder and lay distribution in the United States
تجزیه و تحلیل مقرون به صرفه استراتژی های توزیع naloxone جایگزین: اولین پاسخ دهنده و توزیع در ایالات متحده -2020 Background: The U.S. is facing an unprecedented number of opioid-related overdose deaths, and an array of
other countries have experienced increases in opioid-related fatalities. In the U.S., naloxone is increasingly
distributed to first responders to improve early administration to overdose victims, but its cost-effectiveness has
not been studied. Lay distribution, in contrast, has been found to be cost-effective, but rising naloxone prices and
increased mortality due to synthetic opioids may reduce cost-effectiveness. We evaluate the cost-effectiveness of
increased naloxone distribution to (a) people likely to witness or experience overdose (“laypeople”); (b) police
and firefighters; (c) emergency medical services (EMS) personnel; and (d) combinations of these groups.
Methods: We use a decision-analytic model to analyze the cost-effectiveness of eight naloxone distribution
strategies. We use a lifetime horizon and conduct both a societal analysis (accounting for productivity and
criminal justice system costs) and a health sector analysis. We calculate: the ranking of strategies by net
monetary benefit; incremental cost-effectiveness ratios; and number of fatal overdoses.
Results: High distribution to all three groups maximized net monetary benefit and minimized fatal overdoses; it
averted 21% of overdose deaths compared to minimum distribution. High distribution to laypeople and one of
the other groups comprised the second and third best strategies. The majority of health gains resulted from
increased lay distribution. In the societal analysis, every strategy was cost-saving compared to its next-best
alternative; cost savings were greatest in the maximum distribution strategy. In the health sector analysis, all
undominated strategies were cost-effective. Results were highly robust to deterministic and probabilistic sensitivity
analysis.
Conclusions: Increasing naloxone distribution to laypeople and first responder groups would maximize health
gains and be cost-effective. If feasible, communities should distribute naloxone to all groups; otherwise, distribution
to laypeople and one of the first responder groups should be emphasized. Keywords: Opioids | Naloxone | Cost-effectiveness analysis | Overdose | First responders | Take-home |
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