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

Health Serv Res. 2012 Feb;47(1 Pt 2):523-43. doi: 10.1111/j.1475-6773.2011.01350.x. Epub 2011 Nov 18.


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: NCT00490581.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Case Management / economics*
  • Chronic Disease / economics*
  • Chronic Disease / therapy*
  • Costs and Cost Analysis
  • Female
  • HIV Infections / economics
  • HIV Infections / therapy
  • Health Services / economics
  • Health Services / statistics & numerical data
  • Homeless Persons*
  • Housing / economics*
  • Humans
  • Male
  • Medical Records Systems, Computerized / statistics & numerical data
  • Mental Health
  • Middle Aged
  • Quality of Life
  • Social Work / economics*
  • Socioeconomic Factors
  • Substance-Related Disorders / economics
  • Substance-Related Disorders / therapy

Associated data