Evaluation Of Homelessness Interventions

To calculate the Quality Adjusted Life Years, the following Formula was used:

QALY = Life Years X Utility Weight of Health State X Total Number of Sample Weight

Since, the study participants were transitioning after 3 months, the baseline QALY is calculated at 3 months Life Years or 0.25. The participants transitioned into stable shelters for 6 months. Hence, the QALY is calculated at 0.5 Life Years. The 12 month QALY is again calculated at 0.25 Life years since the participants may move out after the end of study period.  

Table 1 Quality Adjusted Life Years

Non Monetary Benefits include an improvement in QALY

Table 2 :QALY for Group A (AOD Dependent)

Table 3 QALY for Group A (AOD Problems)

Table4 QALY for Group A (No AOD Problems)

Below is the calculation of Monetary Benefit using the Willingness to Pay Given. The Willingness To Paywas multiplied by the number of participants and the life years. Life Years were calculation at 0.25 for Baseline to 6 months, 0.5 years for the month group and 0.25 years for the 12 month evaluation group. The Willingness to Pay(WTP) reflects the Utility to participants in monetary terms. Appropriate WTP is taken for the given calculations. For participants who stay in the same state, the WTP is taken to be the WTP that would be applicable while moving from a worse condition to a better.

Table 4: Monetary Benefits For Group A

Table 5 Monetary Benefits For Group B

Table 6 Monetary Benefits For Group B

Table 7 Net Monetary Benefit Lost due to Death

Table 8 Monetary Benefit for Unstable Housing Residents

Table 9 Monetary Benefit For Participants in Supported Housing

Table 10 Monetary Benefit For Participants in Independent Housing

The following information would be helpful to understand

• If there are any personal costs to the patient during the process and the dollar value of those costs
• If there are any additional costs to the healthcare system  and the dollar value of those costs. 

Valuation in monetary terms has three advantages

• It is a tangible , quantitative measure instead of an abstract , qualitative measure
• The quantitative aspect the costs to the health system and therefore , is better for the formulation of policies and budgeting.

In order to calculate the Present Value, the Net Present Value function was used in Excel. The NPV function was used because the cash flows are irregular i.e the investment amount differs for every period. 

Table 11 PResent Value of Investment at 5% Discount Rate

 Table 12 Present Values at 10% (in Million $)

Arguments for Discounting Costs (Frederick, 1999)

• Discounting Costs helps factor in the time value of money, and hence, is a more efficient way of calculating the true costs/benefits of an investment.
• An public investment is made from scarce public resources and , it is really important to make decisions regarding whether  the future benefits are truly preferable to present consumption.
• Discounting, also, helps understand whether the given investment will provide the desired rate of interest. For example, if a policy states a public good must have at least 10 % of expected returns for approval. Discounting will help understand whether thiscriteria would be fulfilled. 

1. Absorbing States

• Unrelated death
• Related death

1. Non Absorbing States:

• AOD Dependent
• AOD Problems
• No AOD Problems

The uncalculated values are calculated as (1- (Sum of all other probabilities of Transition given)

The following variables must be identified

• Index of Monetary Costs of all interventions
• Index of the Monetary Benefit From Every
• Utility of intervention for group

Table 13 Incremental costs and QALYs per 100 patients over 10 years versus NSA, ordered by increasing benefit

Table 14 Incremental costs and QALYs per 100 patients over 10 years versus NSA, ordered by increasing cost

 A intervention that is both

• higher is terms of ‘Net Benefits provided’
• Has Lower Costs

Is the dominating intervention and dominated other interventions. (Miller & Cantor, 2013)

Extended Dominance implies a situation of weak dominance by a strategy. The weak dominance could be due to lower benefits or higher costs as compared to the next best alternative.(Miller & Cantor, 2013)

1)The first two strategies in table 8 are completed dominated since the other strategies are more cost effective and have greater benefits

2) Calculations

Table 15 Calculation of Cost Benefit Strategy with the Exclusion of the non-dominant strategy

3) The extendedly dominant strategies are

Table 16 Incremental Costs/ Benefits after Extended Domination

In the analysis above, it is seen that

• Supported accom (SA) , SA plus integrated GP , SA plus integrated MHS do not have very high benefits and are very expensive.
• SA plus brief AOD Rx plus pre-employment counseling is very cost effective and has average net benefits.
• SA plus integrated MHS plus job readiness training, SA plus integrated MHS plus job readiness training & supported employment have high benefits but also very high costs.

Hence, SA plus brief AOD Rx plus pre-employment counseling should be the preferred project since it will allow the state to reach out to more people while retaining quality of care.