Health Care Fraud and Abuse Control Program Report for Short-Term Financial Assistance for Veterans Facing Housing Instability Is a Cost-Effective Strategy for Improved Housing[...]

Short-Term Financial Assistance for Veterans Facing Housing Instability Is a Cost-Effective Strategy for Improved Housing Stability and Health-Related Quality of Life

BACKGROUND:
VA partners with community organizations to provide temporary financial assistance (TFA) to Veterans experiencing housing insecurity through the Supportive Services for Veteran Families (SSVF) program. The goal of TFA for housing-related expenses is to prevent homelessness or to quickly house those who have become homeless. This study used a simulation model to compare the costs, quality-adjusted life-years (QALYs), and days of stable housing over two years for a hypothetical cohort of Veterans enrolled in SSVF and experiencing housing insecurity who received TFA vs. those who did not. Depending on whether they were homeless at the time of enrollment or at imminent risk of becoming homeless, Veterans received rapid rehousing services or homelessness prevention services. Cost-effectiveness was measured by the extra cost incurred by VA when a Veteran enrolling in SSVF received TFA to gain 1 additional QALY or day of stable housing compared with not receiving TFA. Researchers performed these calculations separately for Veterans in the rapid rehousing and homelessness prevention components of SSVF, with 10,000 simulations in each group.

FINDINGS:

• Compared to SSVF without TFA for all enrollees, SSVF with TFA yielded improved health benefits at a reasonable cost ($35,814 with TFA vs. $32,562 with no TFA), with more QALYs (1.5 vs. 1.4) and days in stable housing (447 vs. 356).
• At a willingness-to-pay threshold of $150,000 per QALY, TFA was a cost-effective approach for addressing housing insecurity in 90% of the simulations for rapid rehousing and in 88% of the simulations for homelessness prevention only.

IMPLICATIONS:

• Providing short-term financial assistance to Veterans facing housing instability is associated with improved rates of stable housing, lower healthcare costs, and increased QALY, at a reasonable net cost.

LIMITATIONS:

• Results may underestimate the benefits produced by TFA.
• The study's housing status variable was observed at irregular times and extracted using natural language processing, an imperfect measure of housing status.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR. Drs. Nelson and Chaiyakunapruk, and Alec Chapman, Ying Suo, Atim Effiong, and Warren Pettey are with HSR's Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS). Dr. Byrne is with HSR's Center for Healthcare Organization and Implementation Research (CHOIR). Dr. Gelberg is with HSR's Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP).

Nelson RE, Chapman A, Byrne T, Chaiyakunapruk N, Suo Y, Effiong A, Pettey W, Gelberg L, Kertesz SG, Tsai J, Montgomery AE. Cost-Effectiveness of Temporary Financial Assistance for Veterans Experiencing Housing Instability. JAMA Network Open. November 5, 2024;7(11):e2443396.