{"edition":"new-york-city","organization":"The Center for Great Expectations","organizationId":"org:the-center-for-great-expectations","boundaryVersion":"OMB-23-01-2023-07-21","updated":"2026-09-14","model":{"version":"nyc-cge-start-maternal-v1","costScope":"All CGE gross annual resources, not the START program budget. Only a maternal symptom-health component is quantified; complete family, residential and training returns are unpriced.","geographicAttribution":"START's eight listed counties are all inside the official 22-county MSA, so g=1 for this component. Other CGE clients originate in 13 New Jersey counties and do not all receive local credit.","formula":"v=ln(1+d)+rho; A=(1-exp(-v*T))/v; Qall=N*a*b*(p*u*A-h); QMSA=g*Qall; price10=10*costUSD/QMSA if positive. Cost-only sensitivities hold capacity and benefit fixed.","counterfactual":"Public contracts, Medicaid and other treatment providers continue. a discounts alternative treatment; b represents ordinary-gift capacity response. No attribution of national completion-rate gaps or all observed recovery to CGE.","attribution":"N is annual clients, not completions. p translates participation into meaningful clinical improvement, a addresses alternatives, b funding response. Children and residential graduates are not added to the same clients.","uncertainty":"Source-grounded historical reach with subjective clinical and donor priors. Finite duration and recurrence; no lifelong sobriety, avoided overdose or intergenerational QALYs inferred from a testimonial. This price is not a complete portfolio ranking. The short symptom horizon assumes survival through modeled follow-up and does not separately estimate competing death; no mortality-prevention credit is claimed. A longer clinical extrapolation would require explicit competing mortality.","nativeOutcomes":"Annual START participants -> additional effective care -> maternal symptom-related utility improvement, decaying with recurrence -> finite QALYs.","inputs":[{"name":"C","value":8917294,"unit":"USD annual gross resource expense","basis":"observed","rationale":"FY2025 Part IX plus event and bad-debt expense; investment fees already retained.","sourceIds":["return2025","schedule2025"]},{"name":"N","value":53,"unit":"historical annual START clients","basis":"observed","rationale":"2024 count of 53; carrying that historical scale forward is an explicit judgment, not a 2025 observed count.","sourceIds":["impact24"]},{"name":"p","value":0.6,"unit":"meaningful clinical improvement fraction","basis":"judgment","rationale":"Explicit scenario assumption, not a measured CGE success rate or a direct meta-analysis-to-QALY conversion.","sourceIds":["start","clinical"]},{"name":"a","value":0.5,"unit":"additional treatment fraction","basis":"judgment","rationale":"Explicit scenario assumption, not a measured CGE success rate or a direct meta-analysis-to-QALY conversion.","sourceIds":["start","clinical"]},{"name":"b","value":0.5,"unit":"funding response","basis":"judgment","rationale":"Explicit scenario assumption, not a measured CGE success rate or a direct meta-analysis-to-QALY conversion.","sourceIds":["start","clinical"]},{"name":"u","value":0.1,"unit":"health utility improvement","basis":"judgment","rationale":"Explicit scenario assumption, not a measured CGE success rate or a direct meta-analysis-to-QALY conversion.","sourceIds":["start","clinical"]},{"name":"rho","value":0.5,"unit":"annual recurrence/waning hazard","basis":"judgment","rationale":"Explicit scenario assumption, not a measured CGE success rate or a direct meta-analysis-to-QALY conversion.","sourceIds":["start","clinical"]},{"name":"T","value":1,"unit":"maximum effect years","basis":"judgment","rationale":"Explicit scenario assumption, not a measured CGE success rate or a direct meta-analysis-to-QALY conversion.","sourceIds":["start","clinical"]},{"name":"h","value":0.001,"unit":"QALY burden per additional treated person","basis":"judgment","rationale":"Explicit scenario assumption, not a measured CGE success rate or a direct meta-analysis-to-QALY conversion.","sourceIds":["start","clinical"]},{"name":"g","value":1,"unit":"MSA fraction","basis":"judgment","rationale":"All eight currently listed START service counties are in the official MSA; assumes beneficiary residency follows eligibility.","sourceIds":["start","clinical"]},{"name":"d","value":0.03,"unit":"annual discount","basis":"judgment","rationale":"Explicit scenario assumption, not a measured CGE success rate or a direct meta-analysis-to-QALY conversion.","sourceIds":["start","clinical"]}],"scenarios":[{"id":"central","label":"Conditional additional maternal health","costUSD":8917294,"allPopulationQalys":0.6039667239468689,"editionQalys":0.6039667239468689,"pricePer10Qalys":147645452.08262926,"assumptions":"{\"C\":8917294,\"N\":53,\"p\":0.6,\"a\":0.5,\"b\":0.5,\"u\":0.1,\"rho\":0.5,\"T\":1,\"h\":0.001,\"g\":1,\"d\":0.03,\"numeratorCostUSD\":8917294}"},{"id":"low","label":"Mostly alternative treatment and brief improvement","costUSD":8917294,"allPopulationQalys":0.006442458927402261,"editionQalys":0.006442458927402261,"pricePer10Qalys":13841444858.998343,"assumptions":"{\"C\":8917294,\"N\":53,\"p\":0.3,\"a\":0.25,\"b\":0.1,\"u\":0.05,\"rho\":1,\"T\":0.5,\"h\":0.001,\"g\":1,\"d\":0.03,\"numeratorCostUSD\":8917294}"},{"id":"high","label":"Strong additional access with lasting symptom relief","costUSD":8917294,"allPopulationQalys":6.023331494929441,"editionQalys":6.023331494929441,"pricePer10Qalys":14804587.805779498,"assumptions":"{\"C\":8917294,\"N\":53,\"p\":0.8,\"a\":0.75,\"b\":0.75,\"u\":0.2,\"rho\":0.2,\"T\":1.5,\"h\":0.001,\"g\":1,\"d\":0.03,\"numeratorCostUSD\":8917294}"},{"id":"zero","label":"Complete donor replacement","costUSD":8917294,"allPopulationQalys":0,"editionQalys":0,"pricePer10Qalys":null,"assumptions":"{\"C\":8917294,\"N\":53,\"p\":0.6,\"a\":0.5,\"b\":0,\"u\":0.1,\"rho\":0.5,\"T\":1,\"h\":0.001,\"g\":1,\"d\":0.03,\"numeratorCostUSD\":8917294}"},{"id":"adverse","label":"No symptom gain with treatment burden","costUSD":8917294,"allPopulationQalys":-0.1325,"editionQalys":-0.1325,"pricePer10Qalys":null,"assumptions":"{\"C\":8917294,\"N\":53,\"p\":0,\"a\":0.5,\"b\":0.5,\"u\":0.1,\"rho\":0.5,\"T\":1,\"h\":0.01,\"g\":1,\"d\":0.03,\"numeratorCostUSD\":8917294}"},{"id":"partner-cost","label":"Added induced partner resources","costUSD":8957044,"allPopulationQalys":0.6039667239468689,"editionQalys":0.6039667239468689,"pricePer10Qalys":148303600.92467535,"assumptions":"{\"C\":8917294,\"N\":53,\"p\":0.6,\"a\":0.5,\"b\":0.5,\"u\":0.1,\"rho\":0.5,\"T\":1,\"h\":0.001,\"g\":1,\"d\":0.03,\"numeratorCostUSD\":8957044}"},{"id":"volunteer-cost","label":"Unrecognized service-resource stress","costUSD":11146617.5,"allPopulationQalys":0.6039667239468689,"editionQalys":0.6039667239468689,"pricePer10Qalys":184556815.10328656,"assumptions":"{\"C\":8917294,\"N\":53,\"p\":0.6,\"a\":0.5,\"b\":0.5,\"u\":0.1,\"rho\":0.5,\"T\":1,\"h\":0.001,\"g\":1,\"d\":0.03,\"numeratorCostUSD\":11146617.5}"}],"missingInputs":["Current deduplicated START enrollment, treatment intensity, attrition and recurrence.","Counterfactual clinical outcomes with comparable alternative care, not national unmatched rates.","Ordinary-gift response after public funding loss and available Medicaid capacity.","Health trajectories for other residential, outpatient, housing and child services.","Audit details on unrecognized volunteer resources and bad-debt versus resource expenditure."],"sensitivity":["Mostly alternative treatment and brief improvement: 13841444859 USD per 10 MSA QALYs.","Strong additional access with lasting symptom relief: 14804588 USD per 10 MSA QALYs.","Complete donor replacement: no finite positive-benefit price.","No symptom gain with treatment burden: no finite positive-benefit price.","Added induced partner resources: 148303601 USD per 10 MSA QALYs.","Unrecognized service-resource stress: 184556815 USD per 10 MSA QALYs."],"nativeCosts":"Whole annual expense / 53 historical START clients = $168250.83, a portfolio accounting ratio. Central effective additional clinical improvements =53*0.6*0.5*0.5=7.95; full expense / modeled improvement = $1121672.20. These are judgment-based clinical equivalents, not documented recoveries."},"sources":[{"id":"return2023","title":"FY2023 original IRS990","publisher":"CGE / IRS","url":"https://projects.propublica.org/nonprofits/full_text/202431779349301468/IRS990","published":null,"retrieved":"2026-09-14"},{"id":"schedule2023","title":"FY2023 original IRS990ScheduleD","publisher":"CGE / IRS","url":"https://projects.propublica.org/nonprofits/full_text/202431779349301468/IRS990ScheduleD","published":null,"retrieved":"2026-09-14"},{"id":"return2024","title":"FY2024 original IRS990","publisher":"CGE / IRS","url":"https://projects.propublica.org/nonprofits/full_text/202511509349300811/IRS990","published":null,"retrieved":"2026-09-14"},{"id":"schedule2024","title":"FY2024 original IRS990ScheduleD","publisher":"CGE / IRS","url":"https://projects.propublica.org/nonprofits/full_text/202511509349300811/IRS990ScheduleD","published":null,"retrieved":"2026-09-14"},{"id":"return2025","title":"FY2025 original IRS990","publisher":"CGE / IRS","url":"https://projects.propublica.org/nonprofits/full_text/202641809349301399/IRS990","published":null,"retrieved":"2026-09-14"},{"id":"schedule2025","title":"FY2025 original IRS990ScheduleD","publisher":"CGE / IRS","url":"https://projects.propublica.org/nonprofits/full_text/202641809349301399/IRS990ScheduleD","published":null,"retrieved":"2026-09-14"},{"id":"impact24","title":"2024 program and outcome report","publisher":"CGE","url":"https://www.cge-nj.org/wp-content/uploads/2025/04/Impact_Report-for-sharing.pdf","published":null,"retrieved":"2026-09-14"},{"id":"impact25","title":"2025 impact and funding report","publisher":"CGE","url":"https://www.cge-nj.org/wp-content/uploads/2026/02/CGE_Impact_Report_2025.pdf","published":null,"retrieved":"2026-09-14"},{"id":"start","title":"Current START scope and counties","publisher":"CGE","url":"https://www.cge-nj.org/programs/start/","published":null,"retrieved":"2026-09-14"},{"id":"model","title":"Current relational treatment model","publisher":"CGE","url":"https://www.cge-nj.org/our-treatment-model/","published":null,"retrieved":"2026-09-14"},{"id":"clinical","title":"Integrated maternal substance-use treatment review","publisher":"Milligan et al.","url":"https://pubmed.ncbi.nlm.nih.gov/20809957/","published":"2010-09-01","retrieved":"2026-09-14"},{"id":"donate","title":"Official support route","publisher":"CGE","url":"https://www.cge-nj.org/support/","published":null,"retrieved":"2026-09-14"}]}