Health, Costs, and Injection-Related Infections at a Hypothetical Overdose Prevention Center

TL;DR

A hypothetical overdose prevention center in Denver could reduce infections and hospitalizations among drug users while saving healthcare costs over 10 years.

Contribution

This study provides a novel decision-analytic model projecting the long-term health and cost impacts of overdose prevention centers on injection-related infections in the US.

Findings

An overdose prevention center could reduce skin and soft tissue infections by up to 11.5% and infective endocarditis by up to 22.0%.

The center could save between $7 million and $46 million in healthcare costs over 10 years.

Hospitalizations and all-cause mortality among people who inject drugs could decrease by up to 8.5% and 5.8%, respectively.

Abstract

What are the long-term clinical and cost impacts of overdose prevention centers on injection-related infections among people who inject drugs?

In this study of a decision analytical model including US adults who injected drugs, an overdose prevention center in 1 urban center was projected to reduce skin and soft tissue infection incidence, infective endocarditis incidence, and hospitalizations for overdose and infections and save costs to payers over 10 years compared with the status quo of syringe service programs.

These results suggest that overdose prevention centers are cost-saving upstream interventions to mitigate injection-related infections and hospitalizations.

This decision analytical modeling study projects 10-year health and cost outcomes associated with a hypothetical overdose prevention center in a US city.

While the impact of overdose prevention centers (OPCs) on fatal overdose, HIV, and hepatitis C is well-characterized, the long-term clinical and cost impact on injection-related infections is unknown, and empirical data from the US are limited.

To estimate the 10-year impact of a hypothetical OPC in Denver, Colorado, on injection-related infections, hospitalizations, mortality, and associated costs from a payer perspective.

This decision analytical modeling study used a calibrated and validated Monte Carlo microsimulation model of the natural history of injection drug use. Data included people who inject drugs (PWID) in Denver, Colorado, simulated over 10 years, from 2023 to 2032. Input data were largely collected from the 2022 National HIV Behavioral Surveillance survey and published research on currently operating OPCs.

Treatment service model for PWID; the status quo, in which 3 syringe service programs are operating, was compared with counterfactual scenarios in which a single OPC also operated and served between 10% and 70% of Denver’s population of PWID.

Incidence of serious injection-related infections (SIRIs; infective endocarditis [IE] and skin and soft tissue infections [SSTIs]), hospitalizations, mortality, and associated costs from a health care payer perspective.

The modeled population of 9697 PWID had an input mean (SD) age of 41.3 (1.9) years and included 74.1% male participants. Over a 10-year period, the status quo resulted in approximately 15 400 SIRIs, 15 000 hospitalizations for SIRIs and overdose, and 2400 deaths among Denver’s population of PWID. Compared with the status quo scenario, a hypothetical OPC decreased SSTI incidence by up to 11.5% (95% credible interval [CrI], −16.8% to −6.4%), IE incidence by up to 22.0% (95% CrI, −27.6% to −6.1%), hospitalizations by up to 8.5% (95% CrI, −14.0% to −2.6%), and all-cause mortality by up to 5.8% (95% CrI, −12.4% to 4.9%), and saved between $7 million and $46 million from a payer perspective over 10 years, depending on the program reach. Findings were robust in sensitivity analyses.

In this simulation modeling study of the effect of a hypothetical OPC, implementing a single OPC in Denver was an effective intervention to decrease SIRIs, drug use-related hospitalizations, costs, and deaths among PWID.

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