|Equation||(# unsheltered homeless adults) x (% of unsheltered homeless who get assistance solely because of the program) x (% unsheltered homeless would die without intervention) x (% unsheltered homeless saved from death due to the program) x ($ value per life saved)|
|Explanation||This metric estimates the impact of reduced homelessness for previously unsheltered adults living with H.I.V. on life expectancy, estimated in quality-adjusted life years (QALY).
Number of unsheltered adults experiencing homelessness: Reported by program.
Percentage of participants who get assistance solely because of the program: [45%], about 45% of unsheltered homeless would stay outside (Wilder Research, 2016).
Percentage of unsheltered adults who would likely die without intervention: [14%], the odds of death of HIV positive individuals who are homeless are 27 times higher than individuals with housing Spinelli, et al. (2019). We estimate the probability of death between ages 15-64 to be 3.7% based on mortality statistics reported for 2016 by the Minnesota Department of Health. Thus, the estimated likelihood of death of percent of HIV-homeless is: (0.037/0.27 = 0.14)
$ value per life saved: We estimate the value of a life based on a [$50,000] QALY. This value varies by the age and expected years of life of each participant. Thus, we compute the total benefits of a program based on specific program data on participant’s age and discount the annual value to present value using Constellation’s standard discounting method.
|References||Center for Disease Control and Prevention (2017). Retrieved from https://www.cdc.gov/features/homelessness/index.html
Muennig, P., Glied, S. & Simon, J. (2005). Estimation of the health benefits produced by Robin Hood Foundation grant recipients. Report to Robin Hood. New York, NY: Robin Hood.
Morrison, D.S. (2009). Homelessness as an independent risk factor for mortality: results from a retrospective cohort study. International Journal of Epidemiology, 38 (3), 877-83.
MN Compass (2010). Retrieved from https://www.mncompass.org/_pdfs/presentations/BlueCross_HealthInequities_10-10.pdf
Minnesota Department of Health, Center for Health Statistics. Retrieved from: https://mhsq.web.health.state.mn.us/birth/queryFrontPage.jsp?goTo=deathInterfaceSas.jsp&queryPage=deathInterfaceSas.jsp&startQuery=true
Schermer, T. R., Thoonen, B. P, van den Boom, G., Akkermans, R. P., Grol, R. P., Folgering, H. T., van Weel, C. & van Schayck, C. P. (2002). Randomized controlled economic evaluation of asthma self-management in primary health care. American Journal of Respiratory and Critical Care Medicine, 166, 1062-1072.
Spinelli, M. et al. (2019) Homelessness at diagnosis is associated with death among people with HIV in a population-based study of a US city. AIDS: September 1, 2019 – Volume 33 – Issue 11 – p 1789–1794
Wilder Research. (2016). 2015 homeless adults and children: Minnesota statewide survey data. . . Retrieved from http://mnhomeless.org/minnesota-homeless-study/detailed-data-interviews/2015/HennepinCountyMN_Adult2015_Tables51-67.pdf