Background and aims: Although most opioid-related mortality in Australia involves prescription opioids, most research to understand the impact of naloxone supply on opioid-related mortality has focused on people who inject heroin. In this study we aim to examine the cost and likely impact of upscaling naloxone supply to people who are prescribed opioids.
Design: Decision-tree model. Four scenarios were compared to a baseline scenario (the current status quo): naloxone scale-up between 2020-2030 to reach 30% or 90% coverage by 2030, among the subgroups of people prescribed either >=100mg or >=50mg of Oral Morphine Equivalents (OME).
Setting: Australia
Participants: People who are prescribed opioids
Measurements: Possible deaths averted, costs (ambulance and naloxone distribution), and cost-per-life-saved for different scenarios of naloxone scale-up.
Findings: Maintaining the status quo, there would be an estimated 7,478 [Uncertainty Interval (UI) 6,868 – 8,275] prescription opioid overdose deaths between 2020-2030, resulting in AUD51.9 million [49.4, 56.0] in ambulance costs. If naloxone was scaled up to 90% of people prescribed >=50mg OME, an estimated 657 [UI 245, 1,489] deaths could be averted between 2020-2030 (a 20% reduction in the final year of the model compared to the no naloxone scenario), with a cost of AUD43,600 (20,800 – 110,500) per life saved. If naloxone was scaled up to 30% of people prescribed >=50mg OME an estimated 219 (82 - 496) deaths could be averted with the same cost per live saved. If naloxone was restricted to those prescribed >=100mg OME, an estimated 130 (UI 44 - 289) deaths would be averted if scaled up to 30%, or 390 (UI 131 - 866) deaths averted if scaled up to 90%, with the cost-per-life-saved for both scenarios AUD38,200 (UI 12,400 – 97,400).
Conclusion: Scaling up take-home naloxone to reach 90% of people prescribed daily doses of 50mg OME is a low-cost intervention that would save lives.