Online Program

Cost offsets of housing first programs in 5 Canadian cities

Monday, November 4, 2013 : 9:30 a.m. - 9:50 a.m.

Eric Latimer, Ph.D., Psychiatry, McGill University, Verdun, QC, Canada
Paula Goering, RN, PhD, SER, CAMH, Toronto, ON, Canada
Tim Aubry, Ph.D., Psychology, University of Ottawa, Ottawa, ON, Canada
Stephen Hwang, MD, MPH, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St Michael’s Hospital, Toronto, ON, Canada
Sam Tsemberis, Ph.D., Pathways to Housing, New York City, NY
Background Few large and rigorous economic evaluations of Housing First programs have been conducted. Objectives To evaluate the effects on costs at one year of a Housing First intervention in five cities: Vancouver, Winnipeg, Toronto, Montreal and Moncton. Method As part of the At Home study, over 2,200 homeless people with mental illness entered a randomized trial of Housing First (HF) compared to treatment as usual (TAU). Participants with high needs (HN) received a more intensive clinical intervention than participants with moderate needs (MN). Service use and residential data were obtained through questionnaires administered at 6- and 3- month intervals. Actual costs of the intervention were used to replace self-reports, rendering our estimates of cost offsets more conservative. Total costs of health, social and justice service use, excluding medications, were estimated for three consecutive six-month periods starting six months prior to baseline. Results Follow-up rates exceeded 80% overall and were modestly higher in experimental than TAU groups. On average, by the 6-12 month period, HN participants receiving the intervention cost $47,754 compared to $42,992 for TAU participants ($4762, or 11%, more). For MN participants the corresponding figures were $36,585 compared to $31,998 ($4,587, or 13%, more). Discussion Savings from reductions in use of shelters and other resources by HF participants largely offset intervention costs. Considering also effectiveness results reported separately, It would be highly cost-effective to generalize Housing First programs to a much greater number of homeless people with mental illness in Canada.

Learning Areas:

Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs

Learning Objectives:
Describe the methods used to compare the overall costs of a Housing First intervention with services as usual in 5 Canadian cities Compare the costs of the experimental (Housing First) and control (services as usual) groups Discuss the implications of our findings for policy

Keyword(s): Homelessness, Economic Analysis

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a health economist who has led the analysis for the abstract I am proposing to present. The work has been funded by the Mental Health Commission of Canada and I have conducted it as an independent academic researcher without any incentives, financial or otherwise, to introduce any avoidable bias into the analysis or report the results as other than I have found them.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.