Cost-Effectiveness of Expanding Housing Access for People Experiencing Homelessness and Opioid Use Disorder in California
Abstract
People experiencing homelessness (PEH) have substantially lower quality-adjusted life expectancy and substantially higher healthcare spending compared to housed populations. California has the largest population of PEH in the United States, and an estimated ten percent of PEH have co-occurring opioid use disorder (OUD). We developed a lifetime, individual-level microsimulation of the 18,928 PEH with OUD in California to evaluate the health and economic effects of expanding access to housing through a Housing First approach, which does not require OUD treatment or abstinence. Increases in permanent housing and shelter access were based on Los Angeles Countys Measure A goals, and we accounted for both housing and healthcare costs. Expanding housing access increased mean age at death by 0.34 years, reduced fatal overdoses for the cohort by 39, and produced an incremental cost-effectiveness ratio of $31,083 per quality-adjusted life-year gained, well below conventional willingness-to-pay thresholds. We provide evidence that housing is a high-value health intervention for PEH with OUD in California. Policymakers should support Housing First programs as part of integrated responses to the intertwined crises of homelessness and opioid use.
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BibTeX
@misc{ling2026costeffectiveness,
title = {{Cost-Effectiveness of Expanding Housing Access for People Experiencing Homelessness and Opioid Use Disorder in California}},
author = {Yuewei Ling and Sean Tsung and Fernando Alarid-Escudero and Jeremy D. Goldhaber-Fiebert and Margaret L. Brandeau and Marissa B. Reitsma},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.15.26365505},
url = {https://www.medrxiv.org/content/10.64898/2026.10.15.26365505v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Cost-Effectiveness of Expanding Housing Access for People Experiencing Homelessness and Opioid Use Disorder in California
AU - Yuewei Ling
AU - Sean Tsung
AU - Fernando Alarid-Escudero
AU - Jeremy D. Goldhaber-Fiebert
AU - Margaret L. Brandeau
AU - Marissa B. Reitsma
PY - 2026
DA - 2026/10/15
PB - medRxiv
DO - 10.64898/2026.10.15.26365505
UR - https://www.medrxiv.org/content/10.64898/2026.10.15.26365505v1
AB - People experiencing homelessness (PEH) have substantially lower quality-adjusted life expectancy and substantially higher healthcare spending compared to housed populations. California has the largest population of PEH in the United States, and an estimated ten percent of PEH have co-occurring opioid use disorder (OUD). We developed a lifetime, individual-level microsimulation of the 18,928 PEH with OUD in California to evaluate the health and economic effects of expanding access to housing through a Housing First approach, which does not require OUD treatment or abstinence. Increases in permanent housing and shelter access were based on Los Angeles Countys Measure A goals, and we accounted for both housing and healthcare costs. Expanding housing access increased mean age at death by 0.34 years, reduced fatal overdoses for the cohort by 39, and produced an incremental cost-effectiveness ratio of $31,083 per quality-adjusted life-year gained, well below conventional willingness-to-pay thresholds. We provide evidence that housing is a high-value health intervention for PEH with OUD in California. Policymakers should support Housing First programs as part of integrated responses to the intertwined crises of homelessness and opioid use.
ER -