Virtual/Mobile Overdose Response in Canada: A Social Return on Investment Analysis.

Abstract

Objectives: The overdose epidemic continues to be one of the leading causes of death in North America and continues to contribute to high healthcare costs. Although harm reduction initiatives have significantly reduced the aforementioned costs, there is a dearth of evidence regarding overdose response hotlines and applications. We aim to evaluate the social return on investment from a payer perspective of one such overdose response hotline, Canada's National Overdose Response Service, and its implications for service users, service operators, the Canadian healthcare system, and program funders.

Methods: Outcome variables determined from theory of change models were developed in consultation with the aforementioned vested interest groups. Proxy values were attributed to each variable identified through values present within existing literature and databases. These values were then compared with operational costs accounting for deadweight, attribution, and displacement to determine a final social return on investment ratio. A discount rate was then applied based on the influence of risk on the outcome achieved.

Results: The ratio illustrating the value created for all stakeholders, resulting from the $1 592 000 investment made over 2 years, is $15.84 per single dollar invested. The value generated stems primarily from overdose prevention, mental health support, staff employment, reductions in emergency service utilization, service referrals, and volunteer well-being, which outweigh costs including operational funding, work-related stressors, compassion fatigue, and false calls.

Conclusions: The results of our study demonstrate that the National Overdose Response Service provides a social value that far outweighs the costs attributed to the program's operation.