Estimated impact of supervised injection facilities on overdose fatalities and healthcare costs in New York City
Estimated impact of supervised injection facilities on overdose fatalities and healthcare costs in New York City
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DOI：
10.1016/j.jsat.2019.08.010
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发表时间：
2019-11-01
影响因子：
3.9
通讯作者：
Schackman, Bruce R.
中科院分区：
文献类型：
--
作者：
Behrends, Czarina N.;Paone, Denise;Schackman, Bruce R.
阿片类药物在美国的流行仅在2016年就导致超过42，000例美国阿片类药物过量死亡。在纽约市（NYC），阿片类药物过量已达到创纪录的高水平，从2015年至2016年，每10万人中有13.6人过量死亡，增加到19.9人。监督注射设施（SIF）提供了一个卫生，安全的环境，预先获得的药物可以在临床监督下消耗，以快速逆转阿片类药物过量。虽然SIF已在世界范围内实施，但迄今为止在美国尚未实施。本研究估计阿片类药物过量死亡和医疗保健系统的成本实施SIFs在NYC.Methods的潜在影响：一个确定性模型被用来预测致命的阿片类药物过量的数量，避免在纽约市实施SIF。模型输入为2015年至2016年纽约市临时用药过量数据（N = 1852）和文献。医疗保健利用率和成本估计致命的过量，将避免实施一个或多个SIFs.Results：一个最佳放置的SIF估计每年防止19-37阿片类药物过量死亡，代表阿片类药物过量死亡率下降6-12%，该社区;四个最佳放置的SIF估计防止68-131阿片类药物过量死亡。阿片类药物过量每年花费纽约市医疗保健系统估计4100万美元用于紧急医疗服务，急诊室就诊和住院治疗。实施一个SIF估计节省$0.8 $160万，和四个SIF节省$2.9 $570万在每年的医疗保健费用从阿片类药物overdoses.Conclusions：在纽约市实施SIF将挽救生命和医疗保健系统的成本，虽然其整体影响可能是有限的，这取决于当地阿片类药物流行的地理特征。在地理上分散的阿片类药物流行的城市，如纽约市，将需要多个SIF对每年发生的阿片类药物过量死亡总数产生相当大的影响。
Background The opioid epidemic in the United States has resulted in over 42,000 U.S. opioid overdose fatalities in 2016 alone. In New York City (NYC) opioid overdoses have reached a record high, increasing from 13.6 overdose deaths/100,000 to 19.9/100,000 from 2015 to 2016. Supervised injection facilities (SIFs) provide a hygienic, safe environment in which pre-obtained drugs can be consumed under clinical supervision to quickly reverse opioid overdoses. While SIFs have been implemented worldwide, none have been implemented to date in the United States. This study estimates the potential impact on opioid overdose fatalities and healthcare system costs of implementing SIFs in NYC.Methods: A deterministic model was used to project the number of fatal opioid overdoses avoided by implementing SIFs in NYC. Model inputs were from 2015 to 2016 NYC provisional overdose data (N = 1852) and the literature. Healthcare utilization and costs were estimated for fatal overdoses that would have been avoided from implementing one or more SIFs.Results: One optimally placed SIF is estimated to prevent 19-37 opioid overdose fatalities annually, representing a 6-12% decrease in opioid overdose mortality for that neighborhood; four optimally placed SIFs are estimated to prevent 68-131 opioid overdose fatalities. Opioid overdoses cost the NYC healthcare system an estimated $41 million per year for emergency medical services, emergency department visits, and hospitalizations. Implementing one SIF is estimated to save $0.8 $1.6 million, and four SIFs saves $2.9 $5.7 million in annual healthcare costs from opioid overdoses.Conclusions: Implementing SIFs in NYC would save lives and healthcare system costs, although their overall impact may be limited depending on the geographic characteristic of the local opioid epidemic. In cities with geographically dispersed opioid epidemics such as NYC, multiple SIFs will be required to have a sizeable impact on the total number of opioid overdose fatalities occurring each year.