— For communities that experience high rates of overdose, ICER has judged the evidence adequate to demonstrate that supervised injection facilities prevent overdose deaths and reduce overall costs by preventing emergency room visits and hospitalization —
— Evidence suggests that SIFs do not affect crime rates but may decrease public drug consumption —
— At an upcoming December 3 virtual meeting, the New England Comparative Effectiveness Public Advisory Committee will review the evidence, hear further testimony from stakeholders, and deliberate over the comparative clinical effectiveness, other potential benefits, and long-term value for money of constructing and operating these facilities —
BOSTON, November 13, 2020 – The Institute for Clinical and Economic Review (ICER) today released an Evidence Report assessing the comparative clinical effectiveness and economic value of supervised injection facilities (SIFs), as a means to reduce harm among people who inject drugs.
“Before, during, and likely after Covid, the opioid epidemic has been destroying lives and communities,” said David Rind, ICER’s Chief Medical Officer. “Harm reduction is a key objective in managing the opioid epidemic, but even within that framework, many policy makers have hesitated to create sites where people can inject illegal drugs more safely. However, it appears that, to date, no one in the world has ever died of an overdose in a SIF. Beyond that, though, the evidence we reviewed suggests that SIFs actually prevent overdose deaths in the community rather than simply briefly delaying them, and these facilities also reduce expenditures on ambulance calls and hospitalizations. Policy makers should be aware that SIFs save lives and money.”
This Evidence Report is another face of ICER’s work to deliver independent evaluations of the clinical evidence related to a wide-range of potential interventions addressing the opioid crisis, including abuse-deterrent opioid formulations, medication-assisted treatment for opioid use disorder, non-drug interventions for lower back pain, and digital therapeutics for opioid use disorder.
This Evidence Report will be reviewed at a virtual public meeting of the New England Comparative Effectiveness Public Advisory Council (New England CEPAC) on December 3, 2020. The New England CEPAC is one of ICER’s three independent evidence appraisal committees comprising medical evidence experts, practicing clinicians, methodologists, and leaders in patient engagement and advocacy.
A draft version of this report was previously open for a four-week public comment period. The updated Evidence Report and voting questions reflect changes made based on comments received from patient groups, clinicians, drug manufacturers, and other stakeholders. Detailed responses to public comments can be found here.
Key Clinical Findings
The evidence provides high certainty that, compared to syringe service programs (SSPs), SIFs prevent overdose deaths. The degree to which overdose prevention translates to substantially lengthening the life of an individual is uncertain.
The evidence does not suggest that SIFs are correlated with an increase in crime. Some communities have reported increases in needle litter near a SIF, but we do not believe that these possible harms outweigh the benefits in overall harm reduction.
Based on the totality of evidence, ICER is highly certain that SIFs provide for the community at least a small net health benefit, and possibly a substantial one, when compared to SSPs (ICER Evidence Rating: “B+”).
Key Cost-Effectiveness Findings
The costs of operating a SIF were estimated to be higher than operating an SSP. However, those costs were more than offset by cost savings from fewer overdose-related services, such as ambulance calls, emergency room care, and hospitalizations. Furthermore, in all six cities included within the analysis, SIFs were estimated to reduce mortality by avoiding overdose deaths.
In a typical ICER assessment, it is assumed that society is willing to pay more for a new intervention that improves patients’ health, but to be cost-effective, that additional payment should be aligned with the additional benefits those patients receive. However, a SIF is one of the rare interventions that is not only cost-effective, but cost-saving: in communities with high rates of overdose, SIFs save both lives and money.
The Institute for Clinical and Economic Review (ICER) is an independent non-profit research institute that produces reports analyzing the evidence on the effectiveness and value of drugs and other medical services. ICER’s reports include evidence-based calculations of prices for new drugs that accurately reflect the degree of improvement expected in long-term patient outcomes, while also highlighting price levels that might contribute to unaffordable short-term cost growth for the overall health care system.
ICER’s reports incorporate extensive input from all stakeholders and are the subject of public hearings through three core programs: the California Technology Assessment Forum (CTAF), the Midwest Comparative Effectiveness Public Advisory Council (Midwest CEPAC), and the New England Comparative Effectiveness Public Advisory Council (New England CEPAC). These independent panels review ICER’s reports at public meetings to deliberate on the evidence and develop recommendations for how patients, clinicians, insurers, and policymakers can improve the quality and value of health care. For more information about ICER, please visit ICER’s website.