A significant proportion of homeless individuals experience mental illness. Housing First (HF), which provides immediate access to subsidized housing together with support services, has proven to be the most effective approach at helping such individuals access and maintain permanent housing. Previous analyses, using mostly before-and-after comparisons or quasi-experimental designs, have reported significant cost offsets associated with the provision of HF. To our knowledge, only 1 cost-effectiveness analysis, conducted alongside a randomized clinical trial, has been published.
The multiple-site At Home/Chez Soi trial compared outcomes of the scattered-site variant of HF, in which participants receive income-related rent supplements for private market apartments of their choice, with those of treatment as usual (TAU). The trial tested, in parallel, HF with Assertive Community Treatment for people who had more severe mental illness and functional difficulties and HF with Intensive Case Management (ICM) for those whose needs were less acute. Summary results of cost analyses, but not cost-effectiveness analyses, were included in the main trial reports. Herein we report on the cost-effectiveness of HF with ICM compared with TAU.