Comparative cost analysis of housing and case management program for chronically ill homeless adults compared to usual care

Abstract

Objective: To assess the costs of a housing and case management program in a novel sample-homeless adults with chronic medical illnesses.

Data source: The study used data from multiple sources: (1) electronic medical records for hospital, emergency room, and ambulatory medical and mental health visits; (2) institutional and regional databases for days in respite centers, jails, or prisons; and (3) interviews for days in nursing homes, shelters, substance abuse treatment centers, and case manager visits. Total costs were estimated using unit costs for each service.

Study design: Randomized controlled trial of 407 homeless adults with chronic medical illnesses enrolled at two hospitals in Chicago, Illinois, and followed for 18 months.

Principal findings: Compared to usual care, the intervention group generated an average annual cost savings of (-)$6,307 per person (95 percent CI: -16,616, 4,002; p = .23). Subgroup analyses of chronically homeless and those with HIV showed higher per person, annual cost savings of (-)$9,809 and (-)$6,622, respectively. Results were robust to sensitivity analysis using unit costs.

Conclusion: The findings of this comprehensive, comparative cost analyses demonstrated an important average annual savings, though in this underpowered study these savings did not achieve statistical significance.

Trial registration: ClinicalTrials.gov NCT00490581.

Figure 1

Study Diagram

Figure 2

Sensitivity Analyses of Variation in Unit Prices on Mean Incremental Effect on Total Annual Costs. For Each Utilization Category, Unit Prices Are Varied from 50 to 150 percent