Correction: Cost-Effectiveness of Distributing Naloxone to Heroin Users for Lay Overdose Reversal.

BACKGROUND Opioid overdose is a leading cause of accidental death in the United States. OBJECTIVE To estimate the cost-effectiveness of distributing naloxone, an opioid antagonist, to heroin users for use at witnessed overdoses. DESIGN Integrated Markov and decision analytic model using deterministic and probabilistic analyses and incorporating recurrent overdoses and a secondary analysis assuming heroin users are a net cost to society. DATA SOURCES Published literature calibrated to epidemiologic data. TARGET POPULATION Hypothetical 21-year-old novice U.S. heroin user and more experienced users with scenario analyses. TIME HORIZON Lifetime. PERSPECTIVE Societal. INTERVENTION Naloxone distribution for lay administration. OUTCOME MEASURES Overdose deaths prevented and incremental cost-effectiveness ratio (ICER). RESULTS OF BASE-CASE ANALYSIS In the probabilistic analysis, 6% of overdose deaths were prevented with naloxone distribution; 1 death was prevented for every 227 naloxone kits distributed (95% CI, 71 to 716). Naloxone distribution increased costs by $53 (CI, $3 to $156) and quality-adjusted life-years by 0.119 (CI, 0.017 to 0.378) for an ICER of $438 (CI, $48 to $1706). RESULTS OF SENSITIVITY ANALYSIS Naloxone distribution was cost-effective in all deterministic and probabilistic sensitivity and scenario analyses, and it was cost-saving if it resulted in fewer overdoses or emergency medical service activations. In a "worst-case scenario" where overdose was rarely witnessed and naloxone was rarely used, minimally effective, and expensive, the ICER was $14 000. If national drug-related expenditures were applied to heroin users, the ICER was $2429. LIMITATION Limited sources of controlled data resulted in wide CIs. CONCLUSION Naloxone distribution to heroin users is likely to reduce overdose deaths and is cost-effective, even under markedly conservative assumptions. PRIMARY FUNDING SOURCE National Institute of Allergy and Infectious Diseases.