Cost-Utility Analysis of the Housing and Health Intervention for Homeless and Unstably Housed Persons Living with HIV
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We present a cost-utility analysis based on data from the Housing and Health (H&H) Study of rental assistance for homeless and unstably housed persons living with HIV in Baltimore, Chicago and Los Angeles. As-treated analyses found favorable associations of housing with HIV viral load, emergency room use, and perceived stress (an outcome that can be quantitatively linked to quality of life). We combined these outcome data with information on intervention costs to estimate the cost-per-quality-adjusted-life-year (QALY) saved. We estimate that the cost-per-QALY-saved by the HIV-related housing services is $62,493. These services compare favorably (in terms of cost-effectiveness) to other well-accepted medical and public health services.
- Aidala AA, Sumartojo E. Why housing? AIDS Behav. 2007;11(Suppl 6):1–6. CrossRef
- The White House Office of National AIDS Policy. National HIV/AIDS strategy for the United States. Washington, DC: White House; 2010.
- UN General Assembly. Universal Declaration of Human Rights. 10 December 1948, 217 A (III).
- Wolitski RJ, Kidder DP, Pals SL, Royal S, Aidala A, Stall R, Holtgrave DR, Harre D. Housing and Health Study Team. Randomized trial of the effects of housing assistance on the health and risk behaviors of homeless and unstably housed people living with HIV. AIDS Behav. 2010;14(3):493–503. CrossRef
- Leaver CA, Bargh G, Dunn JR, Hwang SW. The effects of housing status on health-related outcomes in people living with HIV: a systematic review of the literature. AIDS Behav. 2007;11(Suppl 6):85–100. CrossRef
- Wolitski RJ, Kidder DP, Fenton KA. HIV, homelessness, and public health: critical issues and a call for increased action. AIDS Behav. 2007;11(Suppl 6):167–71. CrossRef
- Larimer ME, Malone DK, Garner MD, Atkins DC, Burlingham B, Lonczak HS, Tanzer K, Ginzler J, Clifasefi SL, Hobson WG, Marlatt GA. Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA. 2009;301(13):1349–57. CrossRef
- Poulin SR, Maguire M, Metraux S, Culhane DP. Service use and costs for persons experiencing chronic homelessness in Philadelphia: a population-based study. Psychiatr Serv. 2010;61(11):1093–8. CrossRef
- Gilmer TP, Manning WG, Ettner SL. A cost analysis of San Diego County’s REACH program for homeless persons. Psychiatr Serv. 2009;60(4):445–50. CrossRef
- Sadowski LS, Kee RA, VanderWeele TJ, Buchanan D. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA. 2009;301(17):1771–8. CrossRef
- Buchanan D, Kee R, Sadowski LS, Garcia D. The health impact of supportive housing for HIV positive homeless patients: a randomized controlled trial. Am J Public Health. 2009;99 Suppl3:S675-80.
- Basu A, Kee R, Buchanan D, Sadowski LS. Comparative cost analysis of housing and case management program for chronically ill homeless adults compared to usual care. Health Serv Res. 2012;47(1 Pt 2):523–43. CrossRef
- Holtgrave DR, Briddell K, Little E, Bendixen AV, Hooper M, Kidder DP, Wolitski RJ, Harre D, Royal S, Aidala A. Cost and threshold analysis of housing as an HIV prevention intervention. AIDS Behav. 2007;11(Suppl 6):162–6. CrossRef
- Gold MR, Siegel JE, Russell LB, Weinstein MC, editors. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press 1996.
- Walensky RP, Freedberg KA, Weinstein MC, Paltiel AD. Cost-effectiveness of HIV testing and treatment in the United States. Clin Infect Dis. 2007;45(Suppl 4):S248–54. CrossRef
- Chambers JD, Neumann PJ, Buxton MJ. Does Medicare have an implicit cost-effectiveness threshold? Med Decis Making. 2010;30(4):E14–27. CrossRef
- Centers for Disease Control and Prevention. HIV cost-effectiveness, 5 Jan 2012. Available at http://www.cdc.gov/hiv/topics/preventionprograms/ce/index.htm. Accessed 17 Jan 2012.
- Braithwaite RS, Meltzer DO, King JT Jr, Leslie D, Roberts MS. What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule? Med Care. 2008;46(4):349–56. CrossRef
- Schackman BR, Gebo KA, Walensky RP, Losina E, Muccio T, Sax PE, Weinstein MC, Seage GR III, Moore RD, Freedberg KA. The lifetime cost of current human immunodeficiency virus care in the United States. Med Care. 2006;44(11):990–7. CrossRef
- Hawk M, Davis D. The effects of a harm reduction housing program on the viral loads of homeless individuals living with HIV/AIDS. AIDS Care. 2011 Nov 22. [Epub ahead of print].
- Mastro TD, de Vincenzi I. Probabilities of sexual HIV-1 transmission. AIDS 1996 10 (suppl A): S75–82.
- Weaver KE, Antoni MH, Lechner SC, Durán RE, Penedo F, Fernandez MI, Ironson G, Schneiderman N. Perceived stress mediates the effects of coping on the quality of life of HIV-positive women on highly active antiretroviral therapy. AIDS Behav. 2004;8(2):175–83. CrossRef
- Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96. CrossRef
- Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapam S, Oskamp S, editors. The social psychology of health: Claremont symposium on applied social psychology. Newbury Park: Sage; 1988. Pages 31-67.
- Holtgrave DR. Is the Elimination of HIV infection within reach in the United States? lessons from an Epidemiologic Transmission Model. Public Health Rep. 2010;125:372–6.
- Patrick DL, Erickson P. Preventing disease and promoting health: goals for the nation. In health status and health policy allocating resources to health care. New York: Oxford University Press. 1993 292–312.
- Sanders GD, Bayoumi AM, Sundaram V, Bilir SP, Neukermans CP, Rydzak CE, Douglass LR, Lazzeroni LC, Holodniy M, Owens DK. Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med. 2005;352(6):570–85. CrossRef
- Farnham PG, Sansom SL, Hutchinson AB. How much Should we Pay for a new HIV diagnosis? A Mathematical Model of HIV Screening in US Clinical Settings. Med Decis Making. 2012 Jan 12. [Epub ahead of print].
- Grosse SD. Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold. Expert Rev Pharmacoecon Outcomes Res. 2008;8(2):165–78. CrossRef
- Walensky RP. Cost-effectiveness of HIV interventions: from cohort studies and clinical trials to policy. Top HIV Med. 2009;17(4):130–4.
- Paltiel AD, Freedberg KA, Scott CA, Schackman BR, Losina E, Wang B, Seage GR III, Sloan CE, Sax PE, Walensky RP. HIV preexposure prophylaxis in the United States: impact on lifetime infection risk, clinical outcomes, and cost-effectiveness. Clin Infect Dis. 2009;48(6):806–15. CrossRef
- Hornberger J, Holodniy M, Robertus K, Winnike M, Gibson E, Verhulst E. A systematic review of cost-utility analyses in HIV/AIDS: implications for public policy. Med Decis Making. 2007;27(6):789–821. CrossRef
- Hall HI, Holtgrave DR, Maulsby C. HIV transmission rates from persons living with HIV who are aware and unaware of their infection. AIDS. 2012;26:893–6. CrossRef
- Cost-Utility Analysis of the Housing and Health Intervention for Homeless and Unstably Housed Persons Living with HIV
AIDS and Behavior
Volume 17, Issue 5 , pp 1626-1631
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- 1. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Suite 280, Baltimore, MD, 21205, USA
- 2. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- 3. Mailman School of Public Health, Columbia University, New York, NY, USA
- 4. Department of Housing and Urban Development, Washington, DC, USA
- 5. Abt Associates, Inc, Cambridge, MA, USA
- 6. Homeless Services Program, Mayor’s Office of Human Services City of Baltimore, Baltimore, MD, USA
- 7. University of Pittsburgh, Pittsburgh, PA, USA
- 8. AIDS Foundation of Chicago, Chicago, IL, USA