ArticleBMJ open2026
Cost-effectiveness analysis of Canada's National Overdose Response Service.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
4 authors.
Funding
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Abstract
objectivesWe evaluate the cost-effectiveness of Canada's National Overdose Response Service (NORS) and in particular, highlight the conditions under which the cost-effectiveness decision would change, given the uncertainty in estimating the overall risk of fatal and non-fatal overdose in comparison to overall programme costs.
designWe conducted a retrospective cost-effectiveness analysis using a Markov cohort model from a health sector perspective, incorporating health states related to substance use, overdose and mortality. Model parameters were calibrated using Canadian overdose data, and probabilistic sensitivity analyses were performed to assess cost-effectiveness.
settingOur study evaluated Canada's NORS, an overdose response hotline, and reflected community-based substance use settings where overdoses may occur without supervision. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes measured in quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) at a willingness-to-pay threshold of $C100 000 per QALY.
resultsOur model calibration accurately fit fatal overdose targets from 2020 to 2023 and included a total of 9402 calls and 148 overdose events over the study period. We estimated an 11% baseline risk of death for unwitnessed overdoses and a 78% probability of a witnessed overdose. Over a lifetime, NORS was the dominant strategy, yielding 0.46 additional QALYs (95% credible interval (CrI) 0.13 to 1.15) and cost savings of $C25 405 (CrI -$C123 618 to $C24 351). While not cost-effective in the first year (ICER=$C725 843/QALY), NORS became cost-effective beyond 5 years at a $C100 000/QALY threshold. Sensitivity analyses highlighted the cost per NORS call and EMS call-out probability as key cost drivers, while NORS coverage and overdose risk influenced QALYs. NORS remained cost-effective under a broad range of risk and cost scenarios.
conclusionsThe NORS intervention is a cost-effective and cost-saving strategy for reducing fatal overdose risk over a lifetime, offering substantial population-level health benefits and a critical opportunity to mitigate overdose fatalities amid shifting harm reduction policies and threatened supervised consumption site closures.
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