Cost-effectiveness of a ‘Housing First’ programme implemented in Spain: An evaluation based on a randomised controlled trial

Abstract

In the last decades, Housing First model has become a feasible alternative to the traditional “staircase” systems in caring for the most vulnerable homeless people. The analysis that we present in this work is referred to Hábitat, a pioneering HF programme in Spain, which has been evaluated attending to both costs and outcomes. A randomised controlled trial was carried out and the collected data was explored through a Cost-Effectiveness Analysis (CEA), including the estimation of Incremental Cost-Effectiveness Ratios (ICER) and acceptability thresholds of the programme's spending. The results highlight the capacity of the programme to significantly improve the participants' life satisfaction levels, reduce the number of homeless nights, and increase the rate of institutional coverage. Even though the programme involves significant short-term expenditure on accommodation, positive effects in net terms are demonstrated supporting the usefulness and viability of HF model.