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

## TL;DR

The SASH program helps older adults manage cardiovascular risks at home and is cost-effective, improving health outcomes with low costs.

## Contribution

The study demonstrates that the SASH program is cost-effective in reducing cardiovascular risk factors and extending life expectancy.

## Key findings

- SASH significantly improves cardiovascular risk factors in older adults.
- The program extends life expectancy by about 1 year with low cost per QALY gained.
- SASH reduces healthcare spending growth through community-based wellness approaches.

## Abstract

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.

We calculated total quality‐adjusted life years (QALYs) gained from cardiovascular risk reduction and program costs using a Markov model.

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.

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.

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.

What is known on this topic?
○Wellness interventions can aid in helping older adults successfully age in place.○The Support and Services at Home (SASH) is a community‐based program that has been shown to reduce the rate of growth of healthcare spending.
What this study found?
○The SASH program significantly improves cardiovascular risk factors in community‐based older adults, including significant changes in medication rates.○The SASH program extends life expectancy among the enrolled population by approximately 1 year with a very low cost per quality‐adjusted life year gained.

What is known on this topic?
○Wellness interventions can aid in helping older adults successfully age in place.○The Support and Services at Home (SASH) is a community‐based program that has been shown to reduce the rate of growth of healthcare spending.

Wellness interventions can aid in helping older adults successfully age in place.

The Support and Services at Home (SASH) is a community‐based program that has been shown to reduce the rate of growth of healthcare spending.

What this study found?
○The SASH program significantly improves cardiovascular risk factors in community‐based older adults, including significant changes in medication rates.○The SASH program extends life expectancy among the enrolled population by approximately 1 year with a very low cost per quality‐adjusted life year gained.

The SASH program significantly improves cardiovascular risk factors in community‐based older adults, including significant changes in medication rates.

The SASH program extends life expectancy among the enrolled population by approximately 1 year with a very low cost per quality‐adjusted life year gained.