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An economic evaluation of community pharmacy-dispensed naloxone in Canada.
Cid, Ashley; Mahajan, Nikita; Wong, William W L; Beazely, Michael; Grindrod, Kelly A.
Afiliação
  • Cid A; From the School of Pharmacy, University of Waterloo, Kitchener, Ontario.
  • Mahajan N; From the School of Pharmacy, University of Waterloo, Kitchener, Ontario.
  • Wong WWL; From the School of Pharmacy, University of Waterloo, Kitchener, Ontario.
  • Beazely M; From the School of Pharmacy, University of Waterloo, Kitchener, Ontario.
  • Grindrod KA; From the School of Pharmacy, University of Waterloo, Kitchener, Ontario.
Can Pharm J (Ott) ; 157(2): 84-94, 2024.
Article em En | MEDLINE | ID: mdl-38463179
ABSTRACT

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;157xx-xx.

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Can Pharm J (Ott) Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Can Pharm J (Ott) Ano de publicação: 2024 Tipo de documento: Article