LAUSR

AIM To estimate the number of treatment initiations, averted fatal opioid overdoses, and the cost-effectiveness associated with offering buprenorphine-naloxone (buprenorphine) treatment on-site within existing syringe service programs (SSPs) in Massachusetts, USA. DESIGN Cohort-based mathematical model and cost-effectiveness analysis. We derived model inputs from state and national surveillance data, clinical trials, and observational cohort studies. We compared an intervention scenario where 30% of SSP clients-initiated buprenorphine treatment on-site at least once annually to a status quo scenario where no buprenorphine was available onsite. SETTING Community treatment providers in Massachusetts, 2020-2030 PARTICIPANTS: Individuals with opioid use disorder (OUD). We assumed that 80% of SSP clients had recently injected drugs and that treatment within SSPs would have similar or improved retention compared with standard-of-care buprenorphine programs, but higher rates of active opioid use while in treatment. MEASUREMENTS Number of treatment initiations (i.e., individuals began treatment on a medication for opioid use disorder or entered medically managed withdrawal), averted fatal opioid overdoses, quality-adjusted life-years (QALYs), and lifetime discounted costs from a health sector and a limited societal perspective. FINDINGS The status quo scenario resulted in 23,051 fatal overdoses and 1,511,613 treatment initiations over a 10-year simulation period. An intervention scenario with on-site SSP buprenorphine treatment averted 5,015 (-20.8%) fatal opioid overdoses and resulted in 129,359 (+8.6%) additional treatment initiations compared with the status quo. The intervention scenario was the dominating scenario: providing OUD treatment through Massachusetts SSPs cost less (-$3,600 per person), resulting in $775 million in total estimated savings over 10 years, with patients accumulating more QALYs (0.2 per person) compared with the status quo scenario. CONCLUSIONS Offering buprenorphine treatment on-site within syringe service programs has the potential to decrease fatal overdoses substantially, improve treatment engagement, and save on costs.