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Economic Evaluations of Establishing Opioid Overdose Prevention Centers in 12 North American Cities: A Systematic Review

By Jazmine Li April 8, 2024
Overdose prevention centers are a proven intervention in preventing overdose deaths but face continuous legal barriers. OnPoint NYC, photographed above, is one of the two legally sanctioned OPCs in New York City. Photo credit: OnPoint NYC.

In this systematic literature review published in Value in Health, CHERISH Research Affiliates Czarina Behrends and Ahmed Bayoumi, CHERISH staff members Jared Leff, Jazmine Li, and Erminia Fardone, CHERISH investigators Kathryn McCollister, Sean M. Murphy, and Bruce Schackman, and former NIDA summer intern, Weston Lowry, analyzed 16 studies that summarized and identified gaps of economic evidence on establishing overdose prevention centers (OPCs) in North America.

OPCs provide essential services for people who use drugs including harm reduction services, wound care, referrals to treatment programs, and overdose reversals. They still face many legal barriers to implementation and expansion in North America. This literature review aims to inform policymakers of the economic evidence to-date of OPCs. Currently, there are only two legally sanctioned OPCs within the United States located in New York City and an OPC that is anticipated to open in Rhode Island in 2024.

Czarina Behrends, PhD, MPH

Lead author and assistant professor of population health sciences at Weill Cornell Medicine.

The authors used six different databases (PubMed, Embase, Web of Science, EconLit, PsycINFO, and Cost-Effectiveness Analysis (CEA) Registry) to conduct their literature search. After full-text screening of over 4,200 studies, the authors identified 16 studies that met their search criteria. This criterion included peer-reviewed studies written in English and that compared one or more OPC interventions to at least one alternative (e.g., no OPC) in North America using an economic approach (e.g., cost-offset, cost-effectiveness analysis, cost-benefit analysis). All 16 articles were also evaluated against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and Drummond checklists to assess the quality and completeness of the economic study reporting. The articles included:

  • 4 Canadian studies that examined a single OPC (3 in Vancouver, 1 in Calgary) after the programs were established.
  • 7 Canadian studies that looked at scenarios of expanding OPC services within Vancouver, or opening new OPCs in other Canadian cities where they did not yet exist.
  • 5 studies that examined establishing OPCs within the United States where, at the time of publishing, no legally sanctioned OPCs had been established.

Overdose prevention centers are found to be cost-saving or to have favorable cost-effectiveness or cost-benefit ratios in North America, indicating positive economic and health outcomes related to use of these programs where people can consume pre-obtained drugs under supervision and receive immediate medical attention in the event of an overdose.

All studies estimated considerable financial benefits of opening one or more OPCs and this can be summarized below:

  • Studies that included cost-benefit analysis all reported benefit-cost ratios that were greater than 1 (indicating positive net benefit over costs) ranging from 1.26 to 20.6.
  • Studies that estimated cost-offsets estimated between $831,700 (2016 USD) and $2,945,000 (2016 USD) of annual cost offsets to the healthcare system after implementing one OPC.
  • Cost-effectiveness studies that reported quality-adjusted life years (QALYs) saved, estimated cost-effectiveness ratios that were under $50,000 and $100,000 per QALY (the willingness to pay thresholds in Canada and the U.S.).

Based on the research to-date, OPCs are estimated to deliver a positive net health benefit value, while still offsetting a significant amount of money to the healthcare system annually. This review also found that the implementation of OPCs is consistently projected to result in greater benefits than costs.

There are several limitations to this study. Of note, the healthcare systems in Canada and the United States differ tremendously and results from the Canadian and U.S. studies cannot be easily compared. The authors also did not look at studies that took place in Mexico due to the English language search criteria. Future studies need to incorporate experiences of OPCs established in different settings, use a greater range of modeling designs, and consider combined overdose and infectious disease prevention outcomes.

The current economic impact of OPCs may also be underestimated by this review given the fentanyl-contaminated drug supply in North America that has fueled overdose rates. Further research on economic impacts of OPCs using OPC data in this current environment is needed to better estimate the benefits of OPCs in the current overdose crisis. In summary, however, the 16 studies in this review make a compelling economic case for the public health benefits gained from OPCs and scientifically support expansion of these programs.