Permanent Supportive Housing Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness (2018) / Chapter Skim
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4 Cost-Effectiveness of Permanent Supportive Housing
4 Cost-Effectiveness of Permanent Supportive Housing
Pages 58-80
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From page 58... ...
In particular, this chapter responds to the question posed in the statement of task: Is permanent supportive housing cost-effective to those institutions and agencies providing funding for PSH programs? In addressing this question, the committee provides a brief overview of cost-effectiveness analysis (CEA)
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From page 59... ...
• The social reference case should include medical costs as described in the bullet above, time costs for unpaid caregivers, transportation costs, effects on future productivity, and other costs outside the health care sector. • Analysis of the social reference case should include efforts to quantify nonhealth consequences.
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From page 60... ...
The most important induced cost changes that the committee considered are changes in health care costs. Three primary cost changes that are typically observed are due to differences in the utilization of emergency services (including hospital emergency department and prehospital emergency medical services/ambulance costs)
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From page 61... ...
The next set of induced cost changes, specific to PSH studies, concerns changes in shelter stay cost. They include cost changes resulting from using nursing homes (costs that are covered by Medicaid)
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From page 62... ...
Changes in health care costs: 1. Cost changes in emergency services, including emergency department and ambulance costs 2.
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From page 63... ...
Improvements in health (health care utilization and broader measures of health outcomes including reductions in sick days and substance dependence and subjective health quality measures may all be used to generate health benefit)
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From page 64... ...
(2015) reported program cost but not induced cost changes, and Gulcur et al.
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From page 65... ...
The net cost measures after accounting for cost offsets are presented in 2015 constant dollars. For studies with comparison groups, the committee calculated the differences between the intervention and the control group, showing the net effects of intervention polices (difference-in-difference)
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From page 66... ...
66 TABLE 4-1 Summary of Select Studies Examining Cost-Effectiveness of PSH Months Followed % with Mental Disorder/ Housing Comparison Time of After Substance Abuse Study Location Program Study Size Subjects Group Study Treatment Substance Dual Mental Abuse Diagnosis Randomized Controlled Trials Basu et al.
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From page 67... ...
Department of Housing and Urban Development-U.S. Department of Veterans Affairs Supportive Housing program; PSH = permanent supportive housing.
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From page 68... ...
Five studies were excluded because of double-counting (related to changes in emergency department visits, outpatient visits, hospitalized days, and incarcerated days) in the effectiveness measure.
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From page 69... ...
f $2,945g a-gSee Annex 4-1 for further explanation of computational details used in transforming data from cited studies. NOTE: Program costs include difference between experimental and control (per person, per year)
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From page 70... ...
NOTE: ED = emergency department; ES = emergency services.
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From page 71... ...
(2012) considered changes in alternative nursing home and/or shelter stay costs (compared to costs of days spent in permanent supportive housing)
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From page 72... ...
The offsets result primarily from reductions in emergency department and inpatient services costs and from reductions in alternative nursing home and/or shelter stay costs. Net Costs The program cost minus the induced cost offsets yields a measure of the net cost.
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From page 73... ...
−$2,182 1.18 −$2,575 NOTE: Program cost minus induced cost offsets yield a measure of net cost. CONCLUSIONS The committee examined studies that purported to assess the cost-effectiveness of PSH and found that, at present, there is insufficient evidence to demonstrate that the PSH model saves health care costs or is cost-effective.
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From page 74... ...
Generally, these studies suggest that most PSH programs would induce cost offsets that either exceeded the program cost or yielded relatively modest net costs on balance, although this cannot be assumed. Primary cost offsets arise from reductions in emergency department and inpatient services and reductions in alternative nursing home and/or shelter stays.
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From page 75... ...
Recommendation 4-2: Additional research should be undertaken to ad dress current research gaps on cost-effectiveness analysis and the health benefits of permanent supportive housing. ANNEX 4-1: COMPUTATIONAL DETAILS In this Annex, the committee provides further explanation of computational details used in transforming data from cited studies in Tables 4-2, 4-3a, and 4-3b.
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From page 76... ...
. Table 4-3b: Induced Cost Changes (notes a-kk)
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From page 77... ...
] }/3 An nual outpatient care costs including mental health care, medical-surgical care, and homeless case management ($17,267)
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From page 78... ...
(16,281/12,145) Cost reduction for Medicaid outpatient visits is adjusted by the cost weight (ratio between total cost reductions per housing unit [$16,281]
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From page 79... ...
] /2 Mean hospitalized days for VA inpatients are calculated as the difference per person between post- and pre-intervention and between experimental and control groups and are di vided by 2 because the data reported in Culhane et al.
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From page 80... ...
–672 = −(23,856/29) + 4,656/31 Total cost reduction per person is cal culated from outpatient costs for experimental and control groups.
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