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Comparative Cost Analysis of Housing and Case Management Program for Chronically Ill Homeless Adults Compared to Usual Care

Keywords: Homeless;housing and case management;chronic illnesses;randomized;costs.

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.

Conclusions: 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.

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