HEALTH EQUITY IMPACT OF ACADEMIC DETAILING ON NALOXONE DISTRIBUTION IN THE UNITED STATES: AN AGGREGATE DISTRIBUTIONAL COST-EFFECTIVENESS ANALYSIS
Author(s)
Olivia Yip, PharmD1, Zaid Yousif, PharmD, MS2, Nathaniel Hendrix, PharmD, PhD3, Meng Li, MS, PhD4, Aryana Sepassi, MS, PharmD2, Weiming (Ariel) Dong, BS2, Mark Bounthavong, MPH, PharmD, PhD2;
1University of Washington, CHOICE Institute, Seattle, WA, USA, 2University of California, San Diego, Skaggs School of Pharmacy & Pharmaceutical Sciences, La Jolla, CA, USA, 3American Board of Family Medicine, Washington, DC, USA, 4Tufts Medical Center, The Center for the Evaluation of Value and Risk in Health, Boston, MA, USA
1University of Washington, CHOICE Institute, Seattle, WA, USA, 2University of California, San Diego, Skaggs School of Pharmacy & Pharmaceutical Sciences, La Jolla, CA, USA, 3American Board of Family Medicine, Washington, DC, USA, 4Tufts Medical Center, The Center for the Evaluation of Value and Risk in Health, Boston, MA, USA
OBJECTIVES: To evaluate how implementation of an academic detailing program to increase naloxone distribution among opioid users in the United States impacts population health and health equity.
METHODS: An aggregate distributional cost-effectiveness analysis (DCEA) was constructed to model the impact of a national academic detailing program to increase naloxone distribution among opioid users in the United States (US) from the US healthcare payer perspective. Data on health outcomes, such as quality-adjusted life years (QALYs), and costs were based on a hybrid decision tree-Markov model of academic detailing on naloxone distribution using a willingness-to-pay (WTP) threshold of $50,000 per QALY gained. Health opportunity costs and gains were distributed across socio-economic groups based on the Centers for Disease Control and Prevention Social Vulnerability Index quintiles. Equally distributed equivalent (EDE) health was estimated for the US population using the Atkinson inequality aversion index, and the tradeoffs between maximizing health benefits and reducing inequality were displayed on the equity-efficiency plane. Sensitivity analysis was performed by varying the Atkinson inequality index and evaluating its impact on the changes in inequality reduction.
RESULTS: Using a WTP of $50,000 per QALY gained, the estimated incremental net health benefit was 0.08 QALY gained for a typical member of the population when academic detailing was implemented to increase naloxone distribution among opioid users. The incremental EDE health gained was 27,137,383 QALYs and the incremental net health benefit was 27,797,555 QALYs for the entire US population. However, providing academic detailing to the entire US population would worsen inequality by -660,172 QALYs. These findings were robust across a range of Atkinson inequality aversion indices.
CONCLUSIONS: Implementing academic detailing to improve naloxone distribution among opioid users improves health benefits but worsens health inequality for the US population. These findings highlight the difficult tradeoffs between increasing health benefits at the cost of worsening health equity.
METHODS: An aggregate distributional cost-effectiveness analysis (DCEA) was constructed to model the impact of a national academic detailing program to increase naloxone distribution among opioid users in the United States (US) from the US healthcare payer perspective. Data on health outcomes, such as quality-adjusted life years (QALYs), and costs were based on a hybrid decision tree-Markov model of academic detailing on naloxone distribution using a willingness-to-pay (WTP) threshold of $50,000 per QALY gained. Health opportunity costs and gains were distributed across socio-economic groups based on the Centers for Disease Control and Prevention Social Vulnerability Index quintiles. Equally distributed equivalent (EDE) health was estimated for the US population using the Atkinson inequality aversion index, and the tradeoffs between maximizing health benefits and reducing inequality were displayed on the equity-efficiency plane. Sensitivity analysis was performed by varying the Atkinson inequality index and evaluating its impact on the changes in inequality reduction.
RESULTS: Using a WTP of $50,000 per QALY gained, the estimated incremental net health benefit was 0.08 QALY gained for a typical member of the population when academic detailing was implemented to increase naloxone distribution among opioid users. The incremental EDE health gained was 27,137,383 QALYs and the incremental net health benefit was 27,797,555 QALYs for the entire US population. However, providing academic detailing to the entire US population would worsen inequality by -660,172 QALYs. These findings were robust across a range of Atkinson inequality aversion indices.
CONCLUSIONS: Implementing academic detailing to improve naloxone distribution among opioid users improves health benefits but worsens health inequality for the US population. These findings highlight the difficult tradeoffs between increasing health benefits at the cost of worsening health equity.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE447
Topic
Economic Evaluation
Topic Subcategory
Novel & Social Elements of Value
Disease
No Additional Disease & Conditions/Specialized Treatment Areas