{"edition":"los-angeles","organization":"Bienestar Human Services","organizationId":"org:bienestar-human-services","boundaryVersion":"OMB-23-01-2023-07-21","updated":"2026-10-08","display":{"metric":{"id":"daly-equivalent","years":1,"label":"DALY","priceLabel":"$ / DALY"},"priceUSD":9859797.07461669,"canonicalPriceUSDPerTenEquivalentYears":98597970.7461669,"conversion":"display only; QALYs and income equivalents are not measured clinical DALYs"},"listDisplay":{"metric":{"id":"daly-equivalent","years":1,"label":"DALY","priceLabel":"$ / DALY"},"priceUSD":9859797.07461669,"canonicalPriceUSDPerTenEquivalentYears":98597970.7461669,"conversion":"display only; QALYs and income equivalents are not measured clinical DALYs"},"model":{"version":"la-bienestar-clinical-component-v1","costScope":"Full recipient cost; only an explicitly limited clinical component is priced.","geographicAttribution":"g=.95 is a resident-share judgment for LA/Orange, not an observed geographic split.","formula":"ND=B*e/u; NA=M*h*a/ua; NP=M*h*(1-a)/up; A(T)=sum(y=1..T)(1.03^-y). QD=ND*q*t*b/1.03; QA=NA*ea*ta*b*.02*qe/1.03; QP=NP*ep*b*i*.86*v*A(T)/1.03. QLA=(QD+QA+QP)*g; Price10=10*C/QLA. Portfolio Q=QLA+Qother-H; Qother unknown.","counterfactual":"Existing public contracts, pharmacy coverage, ordinary wellness support and alternative care remain. Depression uses a usual-care treatment contrast; ART credit only concerns interruption-sensitive strategy equivalents; PrEP credit only concerns otherwise uncovered risk. Funding responsiveness is additional to clinical compatibility, not a second completion adjustment.","attribution":"Behavioral and medication budgets are disjoint. No HIV-testing count, PrEP enrollment count, therapy-session count or all-client count becomes an outcome. ART and PrEP pools are mutually exclusive; depression/HIV quality areas may still overlap, so totals require validation.","uncertainty":"Subjective conditional best estimate, not empirically calibrated delivery rates or a complete portfolio estimate. Joint stress scenarios are not probability bounds. Zero, adverse effects and omitted health gains remain possible.","nativeOutcomes":"Central budget equivalents: 152.537 depression offers, 129.8348 ART strategy-year resource equivalents, 86.55653333333333 PrEP coverage-year equivalents before eligibility and funding. All-population QALYs: depression 1.055170995145631, ART 0.03939162621359223, PrEP 0.13440032498305424. These are modeled expectations, not observed patients.","inputs":[{"name":"C","value":11511459,"unit":"USD full annual recipient expense","basis":"observed","rationale":"Audit and Part IX agree.","sourceIds":["audit25","99025"]},{"name":"B","value":1525370,"unit":"USD behavioral service expense","basis":"observed","rationale":"Audit functional allocation.","sourceIds":["audit25"]},{"name":"M","value":2596696,"unit":"USD primary-care medicine expense","basis":"observed","rationale":"Audit medicine column; not all primary-care cost.","sourceIds":["audit25"]},{"name":"e","value":0.3,"unit":"compatible depression budget fraction","basis":"judgment","rationale":"No observed diagnosis/course mix; test .1–.6.","sourceIds":["mental"]},{"name":"u","value":3000,"unit":"USD behavioral resources per compatible offer","basis":"judgment","rationale":"Planning assumption, not a measured unit cost; test 1500–6000.","sourceIds":["mental","audit25"]},{"name":"q","value":0.057,"unit":"QALY per randomized depression offer over 12 months","basis":"observed","rationale":"CoBalT effect, not local effectiveness.","sourceIds":["cobalt"]},{"name":"t","value":0.5,"unit":"depression effect transfer","basis":"judgment","rationale":"Different service and population; test .1–1.","sourceIds":["mental","cobalt"]},{"name":"b","value":0.25,"unit":"proportional funding responsiveness","basis":"judgment","rationale":"After public payer, reserve and donor replacement; test .05–.75.","sourceIds":["audit25","award"]},{"name":"g","value":0.95,"unit":"LA/Orange resident share","basis":"judgment","rationale":"LA sites support concentration, not an exact share; test .8–1.","sourceIds":["mental","harm"]},{"name":"h","value":0.8,"unit":"HIV-related share of medicine budget","basis":"judgment","rationale":"Actual drug mix unobserved.","sourceIds":["hiv","prep","audit25"]},{"name":"a","value":0.75,"unit":"ART share of HIV medicine budget","basis":"judgment","rationale":"Complement .25 goes to PrEP; actual mix unobserved.","sourceIds":["hiv","prep"]},{"name":"ua","value":12000,"unit":"medicine USD per ART strategy-year resource equivalent","basis":"judgment","rationale":"Not full treatment cost; all staffing remains in C; test 6000–12000.","sourceIds":["audit25"]},{"name":"up","value":6000,"unit":"medicine USD per PrEP coverage-year equivalent","basis":"judgment","rationale":"Not observed 340B acquisition cost; test 3000–6000.","sourceIds":["audit25"]},{"name":"ea","value":0.25,"unit":"ART equivalents exposed to relevant interruption counterfactual","basis":"judgment","rationale":"Most medication spending does not imply an otherwise interrupted patient; test .05–.5.","sourceIds":["smart","hiv"]},{"name":"ta","value":0.5,"unit":"ART strategy effect transfer","basis":"judgment","rationale":"2006 interruption trial differs from modern care gaps.","sourceIds":["smart"]},{"name":"deltaA","value":0.02,"unit":"composite opportunistic-disease-or-death events per strategy follow-up year","basis":"observed","rationale":"SMART 3.3 versus 1.3 per 100; not a mortality rate or per additional ART year.","sourceIds":["smart"]},{"name":"qe","value":0.5,"unit":"QALY per composite event prevented","basis":"judgment","rationale":"Finite one-year area, no lifetime extrapolation; event mix unobserved.","sourceIds":["smart"]},{"name":"ep","value":0.5,"unit":"PrEP equivalents otherwise uncovered","basis":"judgment","rationale":"Prior care substitution distinct from funding response; test .1–.8.","sourceIds":["siempre","prep"]},{"name":"i","value":0.01,"unit":"annual HIV incidence without PrEP in modeled risk group","basis":"judgment","rationale":"Not Bienestar observed incidence; below PROUD high-risk population; test .002–.03.","sourceIds":["proud"]},{"name":"rP","value":0.86,"unit":"relative HIV reduction","basis":"observed","rationale":"PROUD offer-based effect; no extra completion multiplier.","sourceIds":["proud"]},{"name":"v","value":0.1,"unit":"survival-adjusted utility difference per year after infection prevented","basis":"judgment","rationale":"Finite health-area assumption includes survival differences; no separate life-years added; test .03–.15.","sourceIds":[]},{"name":"T","value":20,"unit":"years of post-infection health area","basis":"judgment","rationale":"No value after year 20; low scenario 10.","sourceIds":[]},{"name":"d","value":0.03,"unit":"annual discount rate","basis":"judgment","rationale":"One-year delivery delay plus explicit HIV trajectory discount.","sourceIds":[]},{"name":"Qother","value":null,"unit":"non-overlapping additional LA QALYs","basis":"unknown","rationale":"Harm reduction, housing, education and other pathways unpriced.","sourceIds":["harm","about"]}],"scenarios":[{"id":"central","label":"Conditional clinical component","costUSD":11511459,"allPopulationQalys":1.2289629463422775,"editionQalys":1.1675147990251635,"assumptions":"{\"e\":0.3,\"u\":3000,\"q\":0.057,\"t\":0.5,\"b\":0.25,\"g\":0.95,\"h\":0.8,\"a\":0.75,\"ua\":12000,\"up\":6000,\"ea\":0.25,\"ta\":0.5,\"qe\":0.5,\"ep\":0.5,\"i\":0.01,\"v\":0.1,\"T\":20} C=11511459; B=1525370; M=2596696; deltaA=.02; rP=.86; d=.03. Joint judgment scenario, not a portfolio bound."},{"id":"low","label":"Weak delivery and transfer","costUSD":11511459,"allPopulationQalys":0.008795082965859052,"editionQalys":0.007036066372687242,"assumptions":"{\"e\":0.1,\"u\":6000,\"q\":0.057,\"t\":0.1,\"b\":0.05,\"g\":0.8,\"h\":0.8,\"a\":0.75,\"ua\":12000,\"up\":6000,\"ea\":0.05,\"ta\":0.5,\"qe\":0.5,\"ep\":0.1,\"i\":0.002,\"v\":0.03,\"T\":10} C=11511459; B=1525370; M=2596696; deltaA=.02; rP=.86; d=.03. Joint judgment scenario, not a portfolio bound."},{"id":"high","label":"Favorable delivery and transfer","costUSD":11511459,"allPopulationQalys":31.602897437326195,"editionQalys":31.602897437326195,"assumptions":"{\"e\":0.6,\"u\":1500,\"q\":0.057,\"t\":1,\"b\":0.75,\"g\":1,\"h\":0.8,\"a\":0.75,\"ua\":6000,\"up\":3000,\"ea\":0.5,\"ta\":0.5,\"qe\":0.5,\"ep\":0.8,\"i\":0.03,\"v\":0.15,\"T\":20} C=11511459; B=1525370; M=2596696; deltaA=.02; rP=.86; d=.03. Joint judgment scenario, not a portfolio bound."},{"id":"zero","label":"Complete substitution or no clinical effect","costUSD":11511459,"allPopulationQalys":0,"editionQalys":0,"assumptions":"b=0."},{"id":"adverse","label":"Illustrative net harm","costUSD":11511459,"allPopulationQalys":-1,"editionQalys":-1,"assumptions":"One LA QALY lost is a stress test, not observed harm."},{"id":"portfolio-unknown","label":"Whole-portfolio return unestimated","costUSD":11511459,"allPopulationQalys":null,"editionQalys":null,"assumptions":"Omitted pathways and overlap remain unresolved."},{"id":"income-unknown","label":"Combined household resources unknown; clinical reference retained","costUSD":11511459,"allPopulationQalys":1.2289629463422775,"editionQalys":1.1675147990251635,"incomeUnknown":true,"assumptions":"Unknown resources are not zero; all six original clinical worlds remain unchanged."}],"sensitivity":["Central price 98597970.7461669; low 16360645835.697964; favorable 3642532.7844793783 USD per 10 LA QALYs.","Depression contributes about 86% of central clinical QALYs; its compatibility and course cost dominate.","Setting ART and PrEP benefits to zero leaves the depression component; setting depression transfer to zero removes most of the estimated benefit.","Doubling funding responsiveness halves the positive component price; budget unit costs, diagnosis mix and untreated incidence are priorities for data collection.","Finite health trajectories avoid repeated lifetime credit; additional public or participant costs would worsen a social-cost price."],"missingInputs":["Unique eligible depression offers and actual resource cost.","Medicine mix, acquisition costs, coverage duration and true alternative coverage.","LA/Orange residence and health outcomes.","Marginal unrestricted funding bottleneck and current contract renewal.","Non-overlapping health effects of harm reduction, MOUD, housing, education and community support."],"incomeAssessment":{"status":"assessed-unknown","scope":"Targeted LA household food, housing assistance, private care payments and participant/caregiver access costs; partial clinical reference retained.","sourceIds":["about","bi-food26","bi-housing26"],"acceptance":"independently-reviewed","evidence":"docs/geography-discovery/la-bienestar-alpha-income-20261008/root-acceptance.md","rationale":"Actual free services and short-term assistance establish resource pathways, but current unique households, retained amounts and alternative private-payment incidence are unidentified. No invented cash central is supplied.","directions":["Joint food, housing and care gains require actual displaced purchases or retained assistance, net taxes and benefit withdrawals, finite duration and additionality against funded public programs.","Full transport, paperwork, time and caregiver burdens survive clinical null; positive health overlap limits gains only.","Provider pharmacy receipts and retail medicines are not household cash; public financing and real-resource costs remain separate."]}},"sources":[{"id":"audit25","title":"FY2025 audited statements, audit dated February 9, 2026; functional table visually verified","url":"https://projects.propublica.org/nonprofits/display_audit/2025-06-GSAFAC-0000403756","publisher":"Bienestar / Federal Audit Clearinghouse","published":null,"retrieved":"2026-09-14"},{"id":"99025","title":"FY2025 original Form 990; submission date","url":"https://projects.propublica.org/nonprofits/full_text/202610929349301506/IRS990","publisher":"Bienestar / IRS","published":"2026-04-02","retrieved":"2026-09-14"},{"id":"99024","title":"FY2024 original Form 990; submission date","url":"https://projects.propublica.org/nonprofits/full_text/202500639349301955/IRS990","publisher":"Bienestar / IRS","published":"2025-03-04","retrieved":"2026-09-14"},{"id":"99023","title":"FY2023 original Form 990; submission date","url":"https://projects.propublica.org/nonprofits/full_text/202400169349302190/IRS990","publisher":"Bienestar / IRS","published":"2024-01-12","retrieved":"2026-09-14"},{"id":"about","title":"Recipient scope and historical timeline","url":"https://www.bienestar.org/about-us/","publisher":"Bienestar","published":null,"retrieved":"2026-10-08"},{"id":"mental","title":"Current bilingual mental-health treatment and locations","url":"https://www.bienestar.org/wellness/mental-health/","publisher":"Bienestar","published":null,"retrieved":"2026-09-14"},{"id":"hiv","title":"Current HIV clinical care","url":"https://www.bienestar.org/clinica-bienestar/hiv-health/","publisher":"Bienestar","published":null,"retrieved":"2026-09-14"},{"id":"prep","title":"Current PrEP prescriptions and access support","url":"https://www.bienestar.org/clinica-bienestar/prep-services/","publisher":"Bienestar","published":null,"retrieved":"2026-09-14"},{"id":"harm","title":"Current syringe services, naloxone and mobile geography","url":"https://www.bienestar.org/community/harm-reduction/","publisher":"Bienestar","published":null,"retrieved":"2026-09-14"},{"id":"siempre","title":"Siempre Seguiré randomized trial","url":"https://pubmed.ncbi.nlm.nih.gov/41085861/","publisher":"Siempre Seguiré investigators / AIDS and Behavior","published":null,"retrieved":"2026-09-14"},{"id":"siempre-full","title":"Original full-text trial, costs and counterevidence","url":"https://www.ebi.ac.uk/europepmc/webservices/rest/PMC12614472/fullTextXML","publisher":"Trial investigators / Europe PMC","published":null,"retrieved":"2026-09-14"},{"id":"adherence","title":"Pilot randomized stigma and ART-adherence trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC8084890/","publisher":"Trial investigators","published":null,"retrieved":"2026-09-14"},{"id":"artas","title":"ARTAS case-management randomized trial","url":"https://pubmed.ncbi.nlm.nih.gov/15750396/","publisher":"Gardner and colleagues / AIDS","published":"2005-03-04","retrieved":"2026-09-14"},{"id":"award","title":"Bienestar Por Vida current CDC award and June 2026 supplement","url":"https://taggs.hhs.gov/Detail/AwardDetail?arg_AwardNum=NU62PS924729&arg_ProgOfficeCode=143","publisher":"US HHS","published":null,"retrieved":"2026-09-14"},{"id":"cobalt","title":"CoBalT randomized clinical and economic evaluation","url":"https://pubmed.ncbi.nlm.nih.gov/24824481/","publisher":"Wiles and colleagues / NIHR","published":null,"retrieved":"2026-09-14"},{"id":"smart","title":"SMART randomized continuous versus interrupted ART strategies","url":"https://www.nejm.org/doi/full/10.1056/NEJMoa062360","publisher":"SMART Study Group / NEJM","published":null,"retrieved":"2026-09-14"},{"id":"proud","title":"PROUD daily PrEP randomized trial","url":"https://pubmed.ncbi.nlm.nih.gov/26364263/","publisher":"McCormack and colleagues / Lancet","published":null,"retrieved":"2026-09-14"},{"id":"bi-food26","title":"Food bank and emergency referrals","publisher":"Bienestar Human Services","url":"https://www.bienestar.org/community/food-bank/","published":null,"retrieved":"2026-10-08"},{"id":"bi-housing26","title":"Short-term housing assistance","publisher":"Bienestar Human Services","url":"https://www.bienestar.org/community/housing/","published":null,"retrieved":"2026-10-08"}]}