Cost and Threshold Analysis of Housing as an HIV Prevention Intervention

Abstract

The Housing and Health study examines the effects of permanent supportive housing for homeless and unstably housed persons living with HIV. While promising as an HIV prevention intervention, providing housing may be more expensive to deliver than some other HIV prevention services. Economic evaluation is needed to determine if investment in permanent supportive housing would be cost-saving or cost-effective. Here we ask -- what is the per client cost of delivering the intervention, and how many HIV transmissions have to be averted in order to exceed the threshold needed to claim cost-savings or cost-effectiveness to society? Standard methods of cost and threshold analysis were employed. Payor perspective costs range from $9,256 to $11,651 per client per year; societal perspective costs range from $10,048 to $14,032 per client per year. Considering that averting a new case of HIV saves an estimated $221,365 in treatment costs, the average cost-saving threshold across the three study cities is 0.0555. Expressed another way, if just one out of every 19 Housing & Health intervention clients avoided HIV transmission to an HIV seronegative partner the intervention would be cost-saving. The intervention would be cost-effective if it prevented just one HIV transmission for every 64 clients served.

Transforming Social Structures And Environments To Help In HIV Prevention

“…45 These data, along with cost-effectiveness and threshold analyses, suggest that providing stable housing to people living with or most vulnerable to HIV infec- tion is an effective strategy to prevent and mitigate HIV and AIDS. [46][47][48] So far, advocates have been successful in using emergent research findings to lobby for subsidized housing programs in at least one locale-Chicago. 49 …”

HIV, Homelessness, and Public Health: Critical Issues and a Call for Increased Action

“…Although outcome data are not yet available, it is reassuring to see the high followup rates (85% at 18 months) achieved in this study. It is even more exciting to see the cost analysis presented by Holtgrave et al (2007), showing that this approach has the very real potential to be cost effective or even cost saving. Obtaining the data to support the cost effectiveness of housing as a public health intervention has the potential to play a major role in shaping not only the future public health response to the HIV epidemic but could also have a substantial impact on housing policy in the United States and elsewhere.…”

Costs, Consequences and Feasibility of Strategies for Achieving the Goals of the National HIV/AIDS Strategy in the United States: A Closing Window for Success?

“…The $28,382 figure [27,28] is higher than the $23,550 often used as an annual costof-illness estimate [23] but the higher figure is more inclusive of all types of care needed by a person living with HIV receiving services in an HIV care system. We estimate here the annual cost of housing to be $12,039 based on earlier empirical work [29].…”