Cost-effectiveness of community-based interventions for reducing opioid overdose and non-overdose deaths: simulation modeling of HEALing communities study

Jagpreet Chhatwal; Mert Sahinkoc; Qiushi Chen; William Dowd; Jade Xiao; Gary A Zarkin; Arnie Aldridge; Joshua A Barocas; Magdalena Cerdá; Naleef Fareed; Lisa A Frazier; Ayaz Hyder; Katherine M Keyes; Charles E Knott; Marc LaRochelle; Benjamin P Linas; Emmanuel Oga; Sara M Roberts; Jeffrey H Samet; Bruce R Schackman; Eric E Seiber; Laura E Starbird; Jennifer Villani; Amy B Knudsen; Carolina Barbosa

Cost-effectiveness of community-based interventions for reducing opioid overdose and non-overdose deaths

simulation modeling of HEALing communities study

Chhatwal, J., Sahinkoc, M., Chen, Q., Dowd, W., Xiao, J., Zarkin, G. A., Aldridge, A., Barocas, J. A., Cerdá, M., Fareed, N., Frazier, L. A., Hyder, A., Keyes, K. M., Knott, C. E., LaRochelle, M., Linas, B. P., Oga, E., Roberts, S. M., Samet, J. H., ... Barbosa, C. (2026). Cost-effectiveness of community-based interventions for reducing opioid overdose and non-overdose deaths: simulation modeling of HEALing communities study. Lancet regional health. Americas, 59, 101480. https://doi.org/10.1016/j.lana.2026.101480

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Abstract

BACKGROUND: The opioid overdose crisis remains a public health emergency in the United States. Evidence-based practices-including medications for opioid use disorder (MOUD) and naloxone distribution-can reduce harms, but their community-level cost-effectiveness is uncertain and may vary locally. We aimed to evaluate the cost-effectiveness of enhanced community-level implementation of evidence-based practices for opioid use disorder (OUD).

METHODS: We used a validated microsimulation model of OUD, calibrated with data from the HEALing Communities Study across 26 highly impacted communities in Massachusetts, New York, and Ohio. Six intervention scenarios for 2025-2030: maintaining 2024 evidence-based practice levels (status quo); improved naloxone distribution; improved MOUD retention; improved MOUD initiation; combined initiation and retention; and combined initiation, retention, and naloxone distribution. Outcomes included opioid overdose deaths (OODs), non-overdose opioid-related deaths, quality-adjusted life years (QALYs), costs (healthcare and societal), and incremental cost-effectiveness ratios (ICERs).

FINDINGS: Maintaining 2024 evidence-based practice levels was projected to yield OODs of 39-468 per 100,000 and non-overdose deaths of 238-3018 per 100,000 across communities. Enhancing MOUD initiation, retention, and naloxone distribution reduced OODs by 15-40% and non-overdose deaths by 7-24%, producing the largest QALY gains (1006-38,292). From the healthcare perspective, improved initiation plus retention was cost-effective in all communities (ICER US$11,765-US$91,058 per QALY); from the societal perspective, all enhanced scenarios were cost-saving (US$121 million-US$4.74 billion net savings).

INTERPRETATION: Community-level enhancement of MOUD initiation and retention, and for some communities also enhancing naloxone distribution, can substantially reduce opioid-related-overdose and non-overdose-deaths. These strategies are cost-effective from a healthcare perspective and cost-saving from a societal perspective, supporting investment in comprehensive, community-tailored interventions.

FUNDING: NIH HEAL Initiative.

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