— Independent appraisal committee determines current evidence is adequate to demonstrate that, compared to syringe exchange programs alone, supervised injection facilities save lives while lowering public health costs —
— At policy roundtable, experts call on community, state, and federal policy leaders to launch pilot SIF programs in areas of established need and with strong local involvement of many sectors of the community, including people who use drugs themselves —
BOSTON, January 8, 2021 – The Institute for Clinical and Economic Review (ICER) today released a Final Evidence Report and Report-at-a-Glance assessing the comparative clinical effectiveness and value of supervised injection facilities (SIFs), as a means to reduce harm among people who inject drugs.
This assessment is another facet 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 (OUD), non-drug interventions for chronic lower back pain, and digital health therapeutics for OUD.
“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,” said David Rind, ICER’s Chief Medical Officer. “However, the evidence we reviewed over the past year – along with the input we received from community leaders, clinical experts, law enforcement, and people who use drugs — suggests that SIFs can deliver a clear public health and economic benefit for communities that currently experience high rates of overdose deaths. SIFs save lives and save money.”
ICER’s report on SIFs was reviewed at the December 2020 public meeting of the New England Comparative Effectiveness Public Advisory Council (New England CEPAC), one of ICER’s three independent evidence appraisal committees.
Voting on Clinical Effectiveness and Contextual Considerations
During the public meeting, the panelists unanimously voted that the evidence is adequate to demonstrate that the net health benefit of SIFs is superior to that provided by syringe service programs (SSPs) alone.
The evidence provides high certainty that, compared to SSPs, SIFs prevent overdose deaths. The degree to which overdose prevention translates to substantially lengthening the life of an individual is uncertain.
During their deliberations, panel members also weighed SIFs’ other potential benefits, disadvantages, and contextual considerations. A majority of the panelists found that SIFs will differentially benefit a historically disadvantaged or underserved community, and that SIFs will significantly reduce the negative impact of OUD on family and caregivers. They also confirmed that ICER’s economic model assumptions were neither too optimistic nor too pessimistic.
Cost-Effectiveness Findings and Voting on Long-Term Value for Money
A majority of the panelists voted that the evidence is adequate to demonstrate that SIFs are cost-saving compared to SSPs.
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.
Key Policy Recommendations
Following the voting session, a policy roundtable of experts — including clinicians, community health workers, advocates for people who use drugs, law enforcement representatives, and state legislators and policymakers — convened to discuss the implications of the evidence for policy and practice. Key recommendations stemming from the roundtable discussion include:
- The evidence is adequate to demonstrate that SIFs save lives and save money. Community, state, and federal policy leaders should move forward to take the steps needed to launch pilot SIF programs in areas of established need and with strong local involvement of many sectors of the community, including, most importantly, people who use drugs themselves.
- The design of SIFs in different locations should be customized to meet local needs and opportunities, guided by needs assessment and community dialogue.
- SIFs should be seen as one part of a broader network of services that can reduce harm, in part by linkages to access medication-assisted treatment (MAT) programs.
- The White House should consider (re)creating a Cabinet-level national leadership position to guide policy development for substance use disorders and the opioid epidemic.
- Research on SIFs should continue in order to generate both generalizable findings and evidence on the broader impact of specific SIFs in their own communities.
- New mechanisms should be developed to ensure the long-term financial sustainability of SIFs following early pilot funding.
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.