{"edition":"california","organization":"Essential Access Health","organizationId":"org:essential-access-health","boundaryVersion":"US-CA-state-v1","updated":"2026-09-14","model":{"version":"ca-essential-ept-slice-v2","costScope":"Whole annual recipient gross recognized costs. Only EPT repeat-infection health priced, not complete portfolio. k includes modeled delivery resources; partner-resource stress tests additional unrecognized costs.","geographicAttribution":"California delivery sites verified, but beneficiaries may include nonresidents: g_CA=.98 subjective, low .9/high1. Not the California share of all Title X or other operations.","formula":"N=C*f/k; infections_all=N*b*delta*t; Q_all=infections_all*v/(1+d); Q_CA=Q_all*g_CA. delta=121/931-92/929. v is already discounted finite QALY loss per avoided infection; d only one-year event timing. P10=10*C/Q_CA. No secondary transmission or repeated lifetime branches.","counterfactual":"Existing public funding and free EPT distribution, ordinary partner referral, Medi-Cal/Family PACT and timely alternative care continue. b discounts donation-dependent delivery beyond them. Current level Title X award is baseline, not an unresolved withholding.","attribution":"Trial strategy effect includes imperfect partner delivery; no second completion/adherence discount. t is external-to-current population/implementation transfer, b funding response. No partner infection health counted separately.","uncertainty":"Allocation, marginal unit resources, patient mix and donation response remain subjective. The community trial has uncertain population effects. Finite clinical conversion is transferred conservatively but not identified for repeat infections in this population.","nativeOutcomes":"Central 23337.961 eligible index-patient offer-equivalents before funding response; 90.2495294937617 repeat infections avoided before geography. Modeled quantities, not medication-log counts.","inputs":[{"name":"C","value":46675922,"unit":"USD/year gross recipient resources","basis":"observed","rationale":"Original2024 full cost plus inventory and donated services.","sourceIds":["990-24","schedule2024"]},{"name":"delta","value":0.030936560222638715,"unit":"absolute repeat-infection risk difference","basis":"observed","rationale":"Trial follow-up counts121/931 minus92/929; not current organization effect.","sourceIds":["trial"]},{"name":"f","value":0.05,"unit":"EPT allocation fraction","basis":"judgment","rationale":"Judgment, not observed ordinary-dollar allocation.","sourceIds":[]},{"name":"k","value":100,"unit":"USD full delivery resources/index-patient offer","basis":"judgment","rationale":"Judgment includes delivery chain, not medication price.","sourceIds":[]},{"name":"b","value":0.25,"unit":"ordinary funding additionality","basis":"judgment","rationale":"Existing free sources/payers and capacity substitution.","sourceIds":[]},{"name":"t","value":0.5,"unit":"clinical and implementation transfer","basis":"judgment","rationale":"Discount for trial follow-up, modern care and uncertain community outcomes.","sourceIds":["community","trial"]},{"name":"v","value":0.01,"unit":"discounted QALY/repeat infection avoided","basis":"judgment","rationale":"Judgment below female modeled losses; no claimed observed sex/pathogen mix, finite sequelae and prompt retreatment matter.","sourceIds":["qaly"]},{"name":"g_CA","value":0.98,"unit":"California resident-health share","basis":"judgment","rationale":"California sites with modest leakage allowance.","sourceIds":["ept"]},{"name":"d","value":0.03,"unit":"annual event-delay discount","basis":"judgment","rationale":"One future-year timing, not second discount of sequela years.","sourceIds":[]},{"name":"Q_other_CA","value":null,"unit":"California QALYs","basis":"unknown","rationale":"Larger reproductive-health and other portfolio effects unpriced.","sourceIds":[]}],"scenarios":[{"id":"central","label":"Conditional EPT central","costUSD":46675922,"editionQalys":0.8586848437270531,"allPopulationQalys":0.8762090242112787,"assumptions":"f=.05;k=100;b=.25;t=.5;v=.01;g=.98;d=.03."},{"id":"low","label":"Weak delivery and low burden","costUSD":46675922,"editionQalys":0.00019767275586206448,"allPopulationQalys":0.00021963639540229388,"assumptions":"f=.01;k=300;b=.05;t=.1;v=.00094;g=.9;d=.03."},{"id":"high","label":"Favorable EPT delivery","costUSD":46675922,"editionQalys":22.43095101980873,"allPopulationQalys":22.43095101980873,"assumptions":"f=.1;k=50;b=.5;t=.8;v=.02;g=1;d=.03."},{"id":"zero","label":"No additional health","costUSD":46675922,"editionQalys":0,"allPopulationQalys":0,"assumptions":"No added delivery or no transfer."},{"id":"adverse","label":"Net adverse stress","costUSD":46675922,"editionQalys":-1,"allPopulationQalys":-1,"assumptions":"One California QALY lost; subjective medication/displacement stress."},{"id":"portfolio","label":"Complete portfolio unknown","costUSD":46675922,"editionQalys":null,"allPopulationQalys":null,"assumptions":"Other effects unpriced."},{"id":"partner-resources","label":"Additional partner-resource stress","costUSD":49009718.1,"allPopulationQalys":0.8762090242112787,"editionQalys":0.8586848437270531,"assumptions":"Add $100 for each C*.05/100 offer-equivalent, beyond k allowance; same health."}],"sensitivity":["Central price $543574541.2415442/10 CA QALYs.","Adding $100 additional partner resources for every modeled offer increases cost by 5%, with no added health.","Setting v to female chlamydia's highest modeled loss without matching population/effect would overstate evidence.","Community-scale effect may be zero; local distribution outputs are not proof otherwise."],"missingInputs":["Current marginal EPT allocation, total delivery cost and unmet eligible demand.","Index-patient pathogen/sex mix, timely alternative treatment and repeat-infection burden.","Gift-induced delivery beyond existing public/free supply.","Other portfolio health, harm and shared-provider resource costs."]},"sources":[{"id":"programs","title":"Current programs and ordinary donation link","url":"https://www.essentialaccess.org/programs-and-services","publisher":"Essential Access Health","published":null,"retrieved":"2026-09-13"},{"id":"titlex26","title":"2026 Title X award received","url":"https://www.essentialaccess.org/about/press-room/essential-access-health-receives-title-x-funding-amid-ongoing-federal-uncertainty","publisher":"Essential Access Health","published":"2026-04-03","retrieved":"2026-09-13"},{"id":"hcai","title":"Current reproductive-health appropriations and administrator procurement","url":"https://hcai.ca.gov/workforce/initiatives/reproductive-health-and-gender-affirming-care-programs/","publisher":"California HCAI","published":null,"retrieved":"2026-09-13"},{"id":"uc25","title":"June 2025 uncompensated-care awards","url":"https://www.essentialaccess.org/about/press-room/essential-access-health-announces-final-awards-californias-uncompensated-care","publisher":"Essential Access Health","published":"2025-06-24","retrieved":"2026-09-13"},{"id":"ept","title":"California free partner-treatment program","url":"https://orders.essentialaccess.org/about","publisher":"Essential Access Health","published":null,"retrieved":"2026-09-13"},{"id":"faq","title":"Partner medication distribution and accountability FAQ","url":"https://orders.essentialaccess.org/faq","publisher":"Essential Access Health","published":null,"retrieved":"2026-09-13"},{"id":"payer","title":"Partner medication and existing payment options","url":"https://www.essentialaccess.org/partner_meds","publisher":"Essential Access Health","published":null,"retrieved":"2026-09-13"},{"id":"trial","title":"Randomized expedited partner treatment trial","url":"https://pubmed.ncbi.nlm.nih.gov/15716561/","publisher":"Golden et al., New England Journal of Medicine","published":"2005-02-17","retrieved":"2026-09-13"},{"id":"community","title":"Washington community randomized EPT implementation trial","url":"https://pubmed.ncbi.nlm.nih.gov/25590331/","publisher":"Golden et al., PLOS Medicine","published":"2015-01-15","retrieved":"2026-09-13"},{"id":"qaly","title":"Modeled quality-adjusted life-year losses per chlamydia and gonorrhea infection","url":"https://academic.oup.com/jid/article/227/8/1007/7046023","publisher":"Li et al., Journal of Infectious Diseases","published":"2023-02-18","retrieved":"2026-09-13"},{"id":"cdc","title":"Current clinical treatment of gonorrhea","url":"https://www.cdc.gov/gonorrhea/hcp/clinical-care/index.html","publisher":"CDC","published":null,"retrieved":"2026-09-13"},{"id":"990-24","title":"Original 2024 Form 990","url":"https://projects.propublica.org/nonprofits/organizations/952564024/202543179349311349/full","publisher":"Essential Access Health / IRS via ProPublica","published":null,"retrieved":"2026-09-13"},{"id":"990-23","title":"Original 2023 Form 990 with 2022 comparative totals","url":"https://projects.propublica.org/nonprofits/organizations/952564024/202403209349311455/full","publisher":"Essential Access Health / IRS via ProPublica","published":null,"retrieved":"2026-09-13"},{"id":"schedule2022","title":"Original 2022 Schedule D expense reconciliation","publisher":"Essential Access Health / IRS","url":"https://projects.propublica.org/nonprofits/full_text/202303199349331230/IRS990ScheduleD","published":null,"retrieved":"2026-09-14"},{"id":"schedule2023","title":"Original 2023 Schedule D expense reconciliation","publisher":"Essential Access Health / IRS","url":"https://projects.propublica.org/nonprofits/full_text/202403209349311455/IRS990ScheduleD","published":null,"retrieved":"2026-09-14"},{"id":"schedule2024","title":"Original 2024 Schedule D expense reconciliation","publisher":"Essential Access Health / IRS","url":"https://projects.propublica.org/nonprofits/full_text/202543179349311349/IRS990ScheduleD","published":null,"retrieved":"2026-09-14"}]}