Economic evaluations of establishing opioid overdose prevention centers in 12 North American cities: a systematic review.
Review
Overview
abstract
OBJECTIVES: Overdose prevention centers (OPCs) provide a safe place where people can consume pre-obtained drugs under supervision so that a life-saving medical response can be provided quickly in the event of an overdose. OPCs are programs that are established in Canada and have recently become legally sanctioned in only a few United States jurisdictions. METHODS: We conducted a systematic review that summarizes and identifies gaps of economic evidence on establishing OPCs in North America to guide future expansion of OPCs. RESULTS: We included 16 final studies that were evaluated with the CHEERS and Drummond checklists. Eight studies reported cost-effectiveness results (e.g., cost per overdose avoided or cost per QALY), with six also including cost-benefit; five reported only cost-benefit results, and three cost-offsets. Health outcomes primarily included overdose mortality outcomes and/or HIV/HCV infections averted. Most studies used mathematical modeling and projected OPC outcomes using the experience of a single facility in Vancouver, BC. CONCLUSIONS: OPCs were found to be cost-saving, or to have favorable cost-effectiveness or cost-benefit ratios across all studies. Future studies should incorporate the experience of OPCs established in various settings and employ a greater diversity of modeling designs.
