Cost‐Effectiveness of the Support and Services at Home ( SASH ) Program for Cardiovascular Risk Factors: A Community‐Based Approach to Healthy Aging in Place

OBJECTIVE: To estimate the cost effectiveness of the Support and Services at Home (SASH) program for health improvements associated with cardiovascular risk factors. Located in affordable housing units, SASH uses wellness approaches to prevent illness, manage chronic conditions and coordinate care delivery by connecting older adults and individuals with disabilities with community-based services. STUDY SETTING AND DESIGN: We calculated total quality-adjusted life years (QALYs) gained from cardiovascular risk reduction and program costs using a Markov model. DATA SOURCES AND ANALYTIC SAMPLE: Data on changes in health status, health outcomes, and programmatic costs were drawn from SASH (primary) data sources from the statewide enrolled population in the original (Vermont) program. Data were collected from 2017 to 2023. PRINCIPAL FINDINGS: SASH reduced total cardiovascular risk factors including increases in appropriate medication use and reductions in systolic blood pressure. The cost per QALY gained ranged from $8344 to $4013 depending on gender and diabetes. CONCLUSIONS: SASH is a cost-effective approach to improving the health of older adults and individuals with disabilities through a housing-based community partnership. SASH is emblematic of the "wrong pocket" problem, so replication and funding of the model are challenging. For greater system efficiency and equity, finding ways to incorporate programs outside the healthcare system will be required.