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The Housing and Health study examines the effects of permanent supportive housing for homeless and unstably housed persons living with HIV. While promising as an HIV prevention intervention, providing housing may be more expensive to deliver than some other HIV prevention services. Economic evaluation is needed to determine if investment in permanent supportive housing would be cost-saving or cost-effective. We asked what is the per client cost of delivering the intervention, and how many HIV transmissions have to be averted in order to exceed the threshold needed to claim cost-savings or cost effectiveness to society? Standard methods of cost and threshold analysis were employed. Payor perspective costs range from $9,256 to $11,651 per client per year; societal perspective costs range from $10,048 to $14,032 per client per year. Considering that averting a new case of HIV saves an estimated $221,365 in treatment costs, the average cost-saving threshold across the three study cities is 0.0555. Expressed another way, if just one out of every 19 Housing & Health intervention clients avoided HIV transmission to an HIV seronegative partner the intervention would be cost-saving. The intervention would be cost-effective if it prevented just one HIV transmission for every 64 clients served.

David Holtgrave is Professor and Chair of the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health. Prior to this, Dr. Holtgrave was Professor of Behavioral Sciences and Health Education, and Professor of Health Policy and Management in the Rollins School of Public Health at Emory University. There he also served as the Director of the Behavioral and Social Science Core of the Center for AIDS Research. He also served as the Vice-Chair of the Department of Behavioral Sciences and Health Education. Before this Dr. Holtgrave was the Director of the Division of HIV/AIDS Prevention Intervention Research and Support in the National Center for HIV, STD and TB Prevention at the Centers for Disease Control and Prevention. The Division has major responsibilities in funding HIV prevention programs, providing technical assistance to HIV prevention service delivery organizations, conducting program evaluation studies, and performing HIV prevention intervention research. Dr. Holtgrave has worked almost exclusively in the field of HIV prevention since 1991. His research has focused on the effectiveness and cost-effectiveness of a variety of HIV prevention interventions, and the relation of the findings of these studies to HIV prevention policy making. He has also investigated the relationship between social capital measures, infectious disease rates, and risk behavior prevalence. He has worked extensively on HIV prevention community planning, and has served as a member of the Wisconsin HIV Prevention Community Planning group. An author and co-author of over 140 professional publications, Dr. Holtgrave has edited The Handbook of Economic Evaluation for HIV Prevention Programs (Plenum Press, 1998).