Case Synopsis

Najwa D'Souza, the CEO of Hampden Health Care, is looking for an intervention that will reduce the rate of discharge to homelessness from the psychiatric units at her hospitals. She is presented with the No Fixed Address (NFA) program as a possible solution. This intervention is a multipronged, hospital-based intervention that provides support to psychiatric clients who are either experiencing homelessness or are at risk of homelessness. To implement the program at Hampden Health Care, hospital staff would refer clients they suspect are at risk of being discharged to homelessness to the NFA program. From there, clients would have the option of receiving streamlined Ontario Works support or seeing a housing advocate who is employed by the local shelter system, Hampden Community House. Excited about the possibilities this intervention holds, Najwa must conduct an economic evaluation to assess the NFA program’s value for money, and support decision making for Hampden Health Care and other relevant stakeholders. Students take the perspective of someone on Najwa’s health economics team. They are given a list of parameters including the types, quantities, and costs per unit of the resources needed for the two interventions being compared (usual care versus NFA program). Students must incorporate the parameters into a model-based economic evaluation comparing the costs and consequences of the alternative interventions. Students are then tasked with working through the rest of the steps to complete a cost-effectiveness analysis.

  1. Review the various steps of conducting an economic evaluation.
  2. Estimate costs and consequences for inclusion in a cost-effectiveness analysis when given a list of parameters (resources required, quantity of resources used, and valuation of resources).
  3. Calculate and interpret incremental cost-effectiveness ratios (ICERs).

Case Objectives

  1. What are the four types of economic evaluations? How do they differ in terms of their valuation of costs and consequences, and their associated key metrics?
  2. Describe the stages of conducting an economic evaluation. How do you see them reflected in the case?
  3. What are the steps of conducting a cost analysis?
  4. Do the ICERs calculated represent good value for money for the different stakeholders represented? Would you recommend moving forward with the program?


Cost-effectiveness analysis, homelessness interventions, incremental cost-effectiveness ratio, No Fixed Address (NFA), value for money



Recommended Citation

Fiedler, M., Lucyk, B., Forchuk, C., & John-Baptiste, A. (2020). No Fixed Address: A Cost-Effectiveness Analysis of a Program to Prevent Psychiatric Discharge to Homelessness in: McKinley, G. & Speechley, M. [eds] Western Public Health Casebook 2020. London, ON: Public Health Casebook Publishing.