Effectiveness of Scotland's National Naloxone Programme for reducing opioid-related deaths: a before (2006-10) versus after (2011-13) comparison.
Effectiveness of Scotland's National Naloxone Programme for reducing opioid-related deaths: a before (2006-10) versus after (2011-13) comparison.
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DOI：
10.1111/add.13265
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发表时间：
2016-05
期刊：
影响因子：
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通讯作者：
Hunter C
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文献类型：
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作者：
Bird SM;McAuley A;Perry S;Hunter C
通过比较 2006-10 年（之前）和 2011-13 年（NNP 于 2011 年 1 月启动后）评估苏格兰国家纳洛酮计划 (NNP) 的有效性，并评估成本效益。这是对国家政策的事前事后评估。通过处方成本与避免阿片类药物相关死亡 (ORD) 所获得的生命年来评估成本效益。 苏格兰，社区环境和所有监狱。存在阿片类药物过量风险的个人可以接受简短的培训和标准化纳洛酮供应。苏格兰国家记录确定的 ORD。回溯确定了在 ORD 之前 4 周内 (i) 出狱（主要结果）和 (ii) 出狱或出院（次要结果）的 ORD 比例。我们报告 2011-13 年与 2006-10 年减少主要（和次要）结果的有效性的置信区间为 95%。根据每次避免 ORD 所获得的 1 或 10 生命年来评估处方成本。 2006-10 年，9.8% 的 ORD（1970 人中的 193 人）是在死亡 4 周内出狱的人，而 2011-13 年只有 6.3% 的 ORD 是在出狱后发生的（1212 人中的 76 人，P < 0.001；这表示差异为 3.5% [95% 置信区间] (CI) = 1.6–5.4%)]。监狱释放 ORD 比例的减少意味着 2011-13 年期间监狱释放 ORD 减少了 42 个（95% CI = 19-65），当时以当前处方费用 225,000 英镑发放了 12,000 个纳洛酮试剂盒。苏格兰的次要结局从 19.0% 降低至 14.9%，差异为 4.1%（95%） CI = 1.4–6.7%）。 苏格兰国家纳洛酮计划于 2011 年启动，该计划使出狱后 4 周内与阿片类药物相关的死亡比例降低了 36%。
To assess the effectiveness for Scotland's National Naloxone Programme (NNP) by comparison between 2006–10 (before) and 2011–13 (after NNP started in January 2011) and to assess cost‐effectiveness. This was a pre–post evaluation of a national policy. Cost‐effectiveness was assessed by prescription costs against life‐years gained per opioid‐related death (ORD) averted. Scotland, in community settings and all prisons. Brief training and standardized naloxone supply became available to individuals at risk of opioid overdose. ORDs as identified by National Records of Scotland. Look‐back determined the proportion of ORDs who, in the 4 weeks before ORD, had been (i) released from prison (primary outcome) and (ii) released from prison or discharged from hospital (secondary). We report 95% confidence intervals for effectiveness in reducing the primary (and secondary) outcome in 2011–13 versus 2006–10. Prescription costs were assessed against 1 or 10 life‐years gained per averted ORD. In 2006–10, 9.8% of ORDs (193 of 1970) were in people released from prison within 4 weeks of death, whereas only 6.3% of ORDs in 2011–13 followed prison release (76 of 1212, P < 0.001; this represented a difference of 3.5% [95% confidence interval (CI) = 1.6–5.4%)]. This reduction in the proportion of prison release ORDs translates into 42 fewer prison release ORDs (95% CI = 19–65) during 2011–13, when 12 000 naloxone kits were issued at current prescription cost of £225 000. Scotland's secondary outcome reduced from 19.0 to 14.9%, a difference of 4.1% (95% CI = 1.4–6.7%). Scotland's National Naloxone Programme, which started in 2011, was associated with a 36% reduction in the proportion of opioid‐related deaths that occurred in the 4 weeks following release from prison.