title: Housing First Impact on Costs and Associated Cost Offsets: A Review of the Literature.
abstract: OBJECTIVE
  Housing First (HF) programs for people who are chronically or episodically homeless, combining rapid access to permanent housing with community-based, integrated treatment, rehabilitation and support services, are rapidly expanding in North America and Europe. Overall costs of services use by homeless people can be considerable, suggesting the potential for significant cost offsets with HF programs. Our purpose was to provide an updated literature review, from 2007 to the present, focusing specifically on the cost offsets of HF programs.
  
  
  METHODS
  A systematic review was performed on MEDLINE and PsycINFO as well as Google and the Homeless Hub for grey literature. Study characteristics and key findings were extracted from identified studies. Where available, impact on service cost associated with HF (increase or decrease) and net impact on overall costs, taking into account the cost of HF intervention, were noted.
  
  
  RESULTS
  Twelve published studies (4 randomized studies and 8 quasi-experimental) and 22 unpublished studies were retained. Shelter and emergency department costs decreased with HF, while impacts on hospitalization and justice costs are more ambiguous. Studies using a pre-post design reported a net decrease in overall costs with HF. In contrast, experimental studies reported a net increase in overall costs with HF.
  
  
  CONCLUSIONS
  While our review casts doubt on whether HF programs can be expected to pay for themselves, the certainty of significant cost offsets, combined with their benefits for participants, means that they represent a more efficient allocation of resources than traditional services.
authors.affiliation: Adviser, Ministère de la santé et des services sociaux du Québec, Montreal, Quebec.
authors.forename: Angela
authors.initials: A
authors.lastname: Ly
authors.affiliation: Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Research Scientist, Douglas Institute Research Centre, Montreal, Quebec.
authors.forename: Eric
authors.initials: E
authors.lastname: Latimer
mesh_terms: D002170:Canada; D003362:Cost-Benefit Analysis; D006301:Health Services Needs and Demand / Q000191:economics*; D006703:Ill-Housed Persons; D006760:Hospitalization / Q000191:economics; D006798:Housing / Q000191:economics*; D006801:Humans; D007603:Jurisprudence; D001523:Mental Disorders / Q000191:economics* / Q000534:rehabilitation; D014481:United States