The Warm Homes for Health project: exploring the cost-effectiveness of improving population health through better housing

Abstract

Housing has a major effect on the health and wellbeing of individuals. There are an estimated 40 000 more deaths in the UK during the coldest months of the year (December to March) than during the rest of the year. Two-thirds of these excess deaths are related to dangerously cold homes. An estimated 20% of the National Health Service clinical budget is spent on avoidable illness (such as cardiovascular and respiratory disease) caused or exacerbated by issues such as poor housing. Housing modifications to improve warmth and damp can help to improve population health. At present there are no data on the cost-effectiveness of improving the warmth of homes through housing modification. The Warm Homes for Health project is a collaboration between public health economists at Bangor University and UK housing providers Gentoo Green and Nottingham City Homes. The project will measure the effect of housing improvements on the health, quality of life, and wellbeing of residents in some of the most socioeconomically disadvantaged areas of the UK.Data will be collected from occupants of retrofitted homes. We will collect data at baseline before housing modification installation and then 6 and 12 months after installation. Outcome measures will include the EQ-5D (for health related quality of life) and the Short Warwick-Edinburgh Mental Well-being Scale. We will also collect individual health and social service use data. We will explore how a cost per quality-adjusted life year (QALY) for housing modification can be calculated for the purpose of comparing relative cost-effectiveness with medical interventions and the National Institute for Health and Care Excellence threshold of £20 000 to £30 000 per QALY. We will produce an incremental cost-effectiveness ratio to examine the incremental cost and quality of life effects of housing improvements. We will use independent t tests between individuals to test the hypothesis that different housing improvements have different effects on quality of life. If we require additional analysis of subgroups we will use one-way repeated measures and between-groups ANOVAs with ad-hoc comparisons. Sensitivity analyses will be used to test uncertainty.We aim to establish whether housing improvements are a cost-effective approach to improving population health. The project is currently ongoing, so there are no results to report. FundingThe Warm Homes for Health project is jointly funded by Gentoo Green and Nottingham City Homes. The funders are also represented on the research team and have provided input into the design of the study, recruitment, data collection, and follow-up.