OBJECTIVES: To assess the value of academic detailing (AD) on naloxone distribution among patients at-risk for an opioid-related overdose or death.

METHODS: A decision tree with an integrated Markov model was constructed to evaluate the cost-effectiveness of AD on naloxone distribution from the payer perspective. The model used a hypothetical cohort of 21-year-old opioid users who interacted with a provider who received a naloxone-related AD (AD group) compared to a similar cohort who did not receive AD (non-AD group). Upon an overdose, a decision tree model simulates the probability of a witnessed opioid-related overdose, utilization of emergency services, and death from the overdose event. The Markov model incorporated the disease course of opioid users and possible transitions between different health states (heroin use, overdose, discontinuation, and death) across a lifetime horizon. Monte Carlo probabilistic sensitivity analysis with 1000 iterations was performed to account for parameter uncertainties. Naloxone cost was based on the federal supply schedule; emergency services costs and utility scores were based on the literature. Total direct costs and quality-adjusted life years (QALYs) were estimated alongside the incremental cost-effectiveness ratio (ICER). Results were presented as the average costs and QALYs with 95% credible interval (CrI). Willingness to pay (WTP) threshold was set at $50,000 per QALY gained.

RESULTS: Average total costs were $2370 and $2263 for the AD-group and non-AD group, respectively; a difference of +$108 (95% CrI: $106, $109). Average QALYs were 0.80 and 0.78 in the AD-group and non-AD-group; a difference of +0.020 QALYs (95% CrI: 0.020, 0.021). The AD-group strategy was associated with an ICER of $ 5354 per QALY gained, which was considered cost-effective.

CONCLUSIONS: AD is a cost-effective, evidence-based intervention that increases health benefits at a moderate cost. Decision makers should consider implementing AD alongside other evidence-based interventions to address the growing opioid epidemic in the US.