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Accounting average, not causal marginal quote."],["marginal_cost_multiplier","Best-estimate prior 1.25; range 1–2.5","2024-to-2026 prices, remote/complex expansion and accounting/output mismatch; not estimated inflation. No second overhead haircut."],["unique_patient_fraction","Prior .85; range .65–1","Reported surgeries may include repeats; only unique care episodes receive first-treatment outcome stream; repeat surgery remains fully costed."],["fistula_fraction","Current provider reports 20% tear cases; working share .8, range .6–.9","Do not apply fistula trial outcomes to perineal tears. Their costs and potential benefits retained/uncredited."],["financial_additionality","Prior .5; range .15–.85, null0","Capacity added beyond public hospitals, NGOs, reserves and donor replacement. Not patient waiting-time catch-up. Current room unknown."],["dry_fraction / partial_fraction","Conservative full operated cohort anchor 21/44 dry, 13/44 partial; favorable transfer .75/.20","Nielsen: 38/44 followed, 37 classified urinary states. All 10 others receive zero durable health (3 persistent, 6 lost, 1 unclassified). No RCT or current portfolio rate. Cautious .4/.3 is a joint transfer scenario, not a lower confidence bound on both fractions."],["dry_utility_gain / partial_utility_gain","Explicit preference-utility priors .25/.08, ranges .1–.35 / 0–.15, signed -0.1/-.05 diagnostics","QoL questionnaires and DALY disability weights are not direct QALYs. Recovery does not imply restored social health; no separate mental-health or income credit."],["advantage_years","Prior5, range1–10, null0","Hard cap on advantage over later public/NGO treatment or recovery, not patient lifetime; actual no-gift waiting-time distribution unavailable."],["delay_years / annual_mortality / annual_effect_decay","Priors .5/.01/.03; ranges 0–2 / 0–.03 / 0–.15","Delay to care, finite survival and recurrence/declining effect after long-term outcome anchor. No lifetime extension or maternal-death benefit."],["procedure_harm_q","Prior .015 per added distinct episode; range0–.1","Gift-date PV total acute harms from every operation/repeat in an added unique episode, including tears; not a per-operation rate. Excludes durable-state worsening. Full present harm without subtracting delayed alternative repair harm is conservative."],["independent_harm_q","Central0, adverse1","Gift-date PV health loss outside patient treatment stream, e.g. displaced other scarce care; no activity multiplier. Do not double count procedure harm."],["external_resource_per_nominal_surgery","Prior$500; range0–1500","Unreimbursed public hospital/noncash staff, patient travel/time, family care, including unsuccessful/repeat/tear procedures. Add on all nominal surgery equivalents. Gross resources, not net induced societal spending."]],"geography":{"all_region":"Direct Africa/Asia health","sf_direct_q":0,"bay_direct_q":0,"sf_indirect":"Unknown, uncredited","bay_indirect":"Unknown, uncredited","note":"US administration is a resource cost, not local health benefit. No local multiplier."},"funding_boundary":"No verified unfunded 2026 tranche. Positive prior permits research ranking, not a guarantee a gift adds care. Public capacity and other NGOs are baseline. Independent donor displacement and eventual patient catch-up are different counterfactuals.","scenarios":[{"id":"central","overrides":{}},{"id":"favorable","overrides":{"marginal_cost_multiplier":1,"unique_patient_fraction":1,"fistula_fraction":0.9,"financial_additionality":0.85,"dry_fraction":0.75,"partial_fraction":0.2,"dry_utility_gain":0.35,"partial_utility_gain":0.12,"advantage_years":10,"delay_years":0.25,"annual_mortality":0.005,"annual_effect_decay":0.01,"procedure_harm_q":0.005,"external_resource_per_nominal_surgery":250}},{"id":"cautious","overrides":{"marginal_cost_multiplier":2,"unique_patient_fraction":0.7,"fistula_fraction":0.7,"financial_additionality":0.2,"dry_fraction":0.4,"partial_fraction":0.3,"dry_utility_gain":0.1,"partial_utility_gain":0.02,"advantage_years":1,"annual_effect_decay":0.1,"procedure_harm_q":0.02,"external_resource_per_nominal_surgery":1000}},{"id":"fast_public_catchup","overrides":{"advantage_years":1}},{"id":"low_additionality","overrides":{"financial_additionality":0.15}},{"id":"higher_complete_cost","overrides":{"marginal_cost_multiplier":2.5,"external_resource_per_nominal_surgery":1500}},{"id":"low_utility_bridge","overrides":{"dry_utility_gain":0.1,"partial_utility_gain":0}},{"id":"no_funding_additionality","overrides":{"financial_additionality":0}},{"id":"zero_health_and_harm","overrides":{"dry_utility_gain":0,"partial_utility_gain":0,"procedure_harm_q":0}},{"id":"no_durable_health_with_procedure_harm","overrides":{"advantage_years":0}},{"id":"signed_worsening","overrides":{"dry_utility_gain":-0.1,"partial_utility_gain":-0.05}},{"id":"independent_harm_zero_activity","overrides":{"financial_additionality":0,"independent_harm_q":1}},{"id":"no_fistula_allocation","overrides":{"fistula_fraction":0}},{"id":"all_external_resources_donor_paid","overrides":{"expense_per_surgery_2024":1589.2510399710616,"external_resource_per_nominal_surgery":0}},{"id":"no_discount","overrides":{"discount_rate":0}}]},"evaluated":[{"id":"central","complete_cash_per_surgery":1486.563799963827,"nominal_surgeries":67.269228540634,"additional_unique_episodes":28.58942212976945,"additional_fistula_episodes":22.871537703815562,"average_utility":0.14295454545454547,"finite_health_years":4.140416816809819,"gross_q":13.537466564051552,"procedure_harm_q":0.4288413319465417,"all_region_q":13.10862523210501,"gift_usd":100000,"gross_resource_usd":133634.61427031702,"donor_per_10q":76285.65027176522,"resource_per_10q":101944.03448427649,"sf_direct_q":0,"bay_direct_q":0,"sf_direct_per_10q":null,"bay_direct_per_10q":null,"sf_indirect_q":null,"bay_indirect_q":null,"status":"positive"},{"id":"favorable","complete_cash_per_surgery":1189.2510399710616,"nominal_surgeries":84.0865356757925,"additional_unique_episodes":71.47355532442363,"additional_fistula_episodes":64.32619979198127,"average_utility":0.2865,"finite_health_years":7.999752454879002,"gross_q":147.4310878012461,"procedure_harm_q":0.35736777662211816,"all_region_q":147.07372002462398,"gift_usd":100000,"gross_resource_usd":121021.63391894812,"donor_per_10q":6799.311255828532,"resource_per_10q":8228.63757703864,"sf_direct_q":0,"bay_direct_q":0,"sf_direct_per_10q":null,"bay_direct_per_10q":null,"sf_indirect_q":null,"bay_indirect_q":null,"status":"positive"},{"id":"cautious","complete_cash_per_surgery":2378.502079942123,"nominal_surgeries":42.04326783789625,"additional_unique_episodes":5.886057497305475,"additional_fistula_episodes":4.1202402481138325,"average_utility":0.046000000000000006,"finite_health_years":0.9150766868568058,"gross_q":0.1734354465837112,"procedure_harm_q":0.11772114994610951,"all_region_q":0.055714296637601704,"gift_usd":100000,"gross_resource_usd":142043.26783789624,"donor_per_10q":17948714.429701652,"resource_per_10q":25494940.510840252,"sf_direct_q":0,"bay_direct_q":0,"sf_direct_per_10q":null,"bay_direct_per_10q":null,"sf_indirect_q":null,"bay_indirect_q":null,"status":"positive"},{"id":"fast_public_catchup","complete_cash_per_surgery":1486.563799963827,"nominal_surgeries":67.269228540634,"additional_unique_episodes":28.58942212976945,"additional_fistula_episodes":22.871537703815562,"average_utility":0.14295454545454547,"finite_health_years":0.9470937354318206,"gross_q":3.096608468108218,"procedure_harm_q":0.4288413319465417,"all_region_q":2.6677671361616766,"gift_usd":100000,"gross_resource_usd":133634.61427031702,"donor_per_10q":374845.3103139945,"resource_per_10q":500923.08454847935,"sf_direct_q":0,"bay_direct_q":0,"sf_direct_per_10q":null,"bay_direct_per_10q":null,"sf_indirect_q":null,"bay_indirect_q":null,"status":"positive"},{"id":"low_additionality","complete_cash_per_surgery":1486.563799963827,"nominal_surgeries":67.269228540634,"additional_unique_episodes":8.576826638930834,"additional_fistula_episodes":6.861461311144668,"average_utility":0.14295454545454547,"finite_health_years":4.140416816809819,"gross_q":4.061239969215466,"procedure_harm_q":0.12865239958396252,"all_region_q":3.932587569631503,"gift_usd":100000,"gross_resource_usd":133634.61427031702,"donor_per_10q":254285.50090588405,"resource_per_10q":339813.4482809217,"sf_direct_q":0,"bay_direct_q":0,"sf_direct_per_10q":null,"bay_direct_per_10q":null,"sf_indirect_q":null,"bay_indirect_q":null,"status":"positive"},{"id":"higher_complete_cost","complete_cash_per_surgery":2973.127599927654,"nominal_surgeries":33.634614270317,"additional_unique_episodes":14.294711064884725,"additional_fistula_episodes":11.435768851907781,"average_utility":0.14295454545454547,"finite_health_years":4.140416816809819,"gross_q":6.768733282025776,"procedure_harm_q":0.21442066597327086,"all_region_q":6.554312616052505,"gift_usd":100000,"gross_resource_usd":150451.9214054755,"donor_per_10q":152571.30054353044,"resource_per_10q":229546.45318106422,"sf_direct_q":0,"bay_direct_q":0,"sf_direct_per_10q":null,"bay_direct_per_10q":null,"sf_indirect_q":null,"bay_indirect_q":null,"status":"positive"},{"id":"low_utility_bridge","complete_cash_per_surgery":1486.563799963827,"nominal_surgeries":67.269228540634,"additional_unique_episodes":28.58942212976945,"additional_fistula_episodes":22.871537703815562,"average_utility":0.04772727272727273,"finite_health_years":4.140416816809819,"gross_q":4.5196629228153045,"procedure_harm_q":0.4288413319465417,"all_region_q":4.090821590868763,"gift_usd":100000,"gross_resource_usd":133634.61427031702,"donor_per_10q":244449.67295374797,"resource_per_10q":326669.37753679254,"sf_direct_q":0,"bay_direct_q":0,"sf_direct_per_10q":null,"bay_direct_per_10q":null,"sf_indirect_q":null,"bay_indirect_q":null,"status":"positive"},{"id":"no_funding_additionality","complete_cash_per_surgery":1486.563799963827,"nominal_surgeries":67.269228540634,"additional_unique_episodes":0,"additional_fistula_episodes":0,"average_utility":0.14295454545454547,"finite_health_years":4.140416816809819,"gross_q":0,"procedure_harm_q":0,"all_region_q":0,"gift_usd":100000,"gross_resource_usd":133634.61427031702,"donor_per_10q":null,"resource_per_10q":null,"sf_direct_q":0,"bay_direct_q":0,"sf_direct_per_10q":null,"bay_direct_per_10q":null,"sf_indirect_q":null,"bay_indirect_q":null,"status":"zero"},{"id":"zero_health_and_harm","complete_cash_per_surgery":1486.563799963827,"nominal_surgeries":67.269228540634,"additional_unique_episodes":28.58942212976945,"additional_fistula_episodes":22.871537703815562,"average_utility":0,"finite_health_years":4.140416816809819,"gross_q":0,"procedure_harm_q":0,"all_region_q":0,"gift_usd":100000,"gross_resource_usd":133634.61427031702,"donor_per_10q":null,"resource_per_10q":null,"sf_direct_q":0,"bay_direct_q":0,"sf_direct_per_10q":null,"bay_direct_per_10q":null,"sf_indirect_q":null,"bay_indirect_q":null,"status":"zero"},{"id":"no_durable_health_with_procedure_harm","complete_cash_per_surgery":1486.563799963827,"nominal_surgeries":67.269228540634,"additional_unique_episodes":28.58942212976945,"additional_fistula_episodes":22.871537703815562,"average_utility":0.14295454545454547,"finite_health_years":0,"gross_q":0,"procedure_harm_q":0.4288413319465417,"all_region_q":-0.4288413319465417,"gift_usd":100000,"gross_resource_usd":133634.61427031702,"donor_per_10q":null,"resource_per_10q":null,"sf_direct_q":0,"bay_direct_q":0,"sf_direct_per_10q":null,"bay_direct_per_10q":null,"sf_indirect_q":null,"bay_indirect_q":null,"status":"harm"},{"id":"signed_worsening","complete_cash_per_surgery":1486.563799963827,"nominal_surgeries":67.269228540634,"additional_unique_episodes":28.58942212976945,"additional_fistula_episodes":22.871537703815562,"average_utility":-0.0625,"finite_health_years":4.140416816809819,"gross_q":-5.918606208448612,"procedure_harm_q":0.4288413319465417,"all_region_q":-6.347447540395153,"gift_usd":100000,"gross_resource_usd":133634.61427031702,"donor_per_10q":null,"resource_per_10q":null,"sf_direct_q":0,"bay_direct_q":0,"sf_direct_per_10q":null,"bay_direct_per_10q":null,"sf_indirect_q":null,"bay_indirect_q":null,"status":"harm"},{"id":"independent_harm_zero_activity","complete_cash_per_surgery":1486.563799963827,"nominal_surgeries":67.269228540634,"additional_unique_episodes":0,"additional_fistula_episodes":0,"average_utility":0.14295454545454547,"finite_health_years":4.140416816809819,"gross_q":0,"procedure_harm_q":0,"all_region_q":-1,"gift_usd":100000,"gross_resource_usd":133634.61427031702,"donor_per_10q":null,"resource_per_10q":null,"sf_direct_q":0,"bay_direct_q":0,"sf_direct_per_10q":null,"bay_direct_per_10q":null,"sf_indirect_q":null,"bay_indirect_q":null,"status":"harm"},{"id":"no_fistula_allocation","complete_cash_per_surgery":1486.563799963827,"nominal_surgeries":67.269228540634,"additional_unique_episodes":28.58942212976945,"additional_fistula_episodes":0,"average_utility":0.14295454545454547,"finite_health_years":4.140416816809819,"gross_q":0,"procedure_harm_q":0.4288413319465417,"all_region_q":-0.4288413319465417,"gift_usd":100000,"gross_resource_usd":133634.61427031702,"donor_per_10q":null,"resource_per_10q":null,"sf_direct_q":0,"bay_direct_q":0,"sf_direct_per_10q":null,"bay_direct_per_10q":null,"sf_indirect_q":null,"bay_indirect_q":null,"s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