{"edition":"usa","organization":"Institute for Progress","organizationId":"ein:87-2449729","boundaryVersion":"USA-50-states-DC-v1","updated":"2026-09-30","display":{"metric":{"id":"daly-equivalent","years":1,"label":"DALY","priceLabel":"$ / DALY"},"priceUSD":32510.779288200014,"canonicalPriceUSDPerTenEquivalentYears":325107.79288200015,"conversion":"display only; QALYs and income equivalents are not measured clinical DALYs"},"listDisplay":{"metric":{"id":"daly-equivalent","years":1,"label":"DALY","priceLabel":"$ / DALY"},"priceUSD":32510.779288200014,"canonicalPriceUSDPerTenEquivalentYears":325107.79288200015,"conversion":"display only; QALYs and income equivalents are not measured clinical DALYs"},"model":{"version":"usa-ifp-calibrated-20260930-income","costScope":"Latest original 2024 annual charitable-entity expense, charged once as an annual-work comparator, not a current marginal gift offer. Income resource savings net modeled implementation/production costs; unmeasured external health-system and public costs remain limitations.","geographicAttribution":"90% of conditional patient benefit attributed to U.S. residents; not a measured geography share. Income uses only net gains during U.S. residence or U.S. consumer/owner incidence; geography adjustments in native savings and recipient cohorts are not applied twice.","formula":"patients*annualQalyGain*earlierYears*reformProbability*approvalProbability*incrementalBenefitProbability*organizationAttribution*fundingAdditionality*usShare/(1+discountRate)^delayYears; dollars per better life = 10 × annual cost / discounted U.S. QALYs; annual-cost fundingAdditionality=1; combined price=10*annualCostUSD/(U.S. health QALYs + sum .5*people*ln(1+gain/baseline)*causalShare*editionShare*independentShare*sum annual discount weights).","counterfactual":"Other advocates and regulators may enact the same reform; existing funders may support the same work and many affected drug candidates fail.","attribution":"Annual-work causal contribution and implementation probability apply once to each pathway. FundingAdditionality=1 for the annual-cost central comparison; old marginal-funding factors remain sensitivities only. Do not credit future gifts with past achievements or count collaborative wins twice.","uncertainty":"Central/low/high are transparent joint hypotheses, not posterior estimates or confidence intervals. Distinct conditionals are logically meaningful but no source identifies their product. Show undiscounted conditional benefits and total causal share so compounded skepticism is visible. Do not multiply portfolio scale by an invented count. No universal GDP-to-income conversion. Second cohort explicitly subtracts illustrative local wage/competition losses using signed log income. Numbers are stress assumptions; housing pressure, public-service costs, origin-country brain drain and family disruption remain unmeasured. For a USA estimate origin-country welfare is outside geography but should be disclosed.","nativeOutcomes":"Policy analysis and implementation support could let additional skilled workers stay and earn more, as well as improve clinical development. The income cohort and causal share are hypotheses, not observed placements.","inputs":[{"name":"patients","value":100000,"unit":"people","basis":"judgment","rationale":"One candidate-equivalent reaching this many recipients if useful treatment is delivered. Retained conditional scale prior, not an observed beneficiary count or a verified number of affected candidates.","sourceIds":[]},{"name":"annualQalyGain","value":0.1,"unit":"QALYs/person-year","basis":"judgment","rationale":"Annual incremental health gain conditional on useful treatment. This does not already average ineffective approved products; the separate incremental-benefit probability does that.","sourceIds":[]},{"name":"earlierYears","value":0.25,"unit":"years","basis":"judgment","rationale":"Effective-care or generation acceleration relative to the counterfactual, not time saved on an administrative step. Revised timing judgment; no measured org-specific lead.","sourceIds":[]},{"name":"reformProbability","value":0.25,"unit":"fraction","basis":"judgment","rationale":"Probability of an additional useful operational policy change from the modeled work. Does not credit a new gift with already enacted reforms; judgment, not measured causal probability.","sourceIds":[]},{"name":"approvalProbability","value":0.079,"unit":"fraction","basis":"judgment","rationale":"Historical Phase-I-to-approval likelihood of 7.9% in BIO/Informa/QLS 2011–2020. Used as an analogical prior, not an organization-specific rate; disease and modality mix can differ.","sourceIds":["bio-2011-2020"]},{"name":"incrementalBenefitProbability","value":0.5,"unit":"fraction","basis":"judgment","rationale":"Probability of useful additional care conditional on approval, distinct from regulatory approval and from the conditional magnitude of benefit. Judgment, not a measured share.","sourceIds":[]},{"name":"organizationAttribution","value":0.1,"unit":"fraction","basis":"judgment","rationale":"Incremental organizational contribution within a collaborative policy ecosystem, conditional on useful reform. Judgment; overlapping advocates are not separate independent wins.","sourceIds":[]},{"name":"fundingAdditionality","value":1,"unit":"fraction","basis":"judgment","rationale":"Annual-work comparator: no extra donor haircut on full annual expense. Prior factor remains sensitivity, not a measured marginal offer.","sourceIds":[]},{"name":"usShare","value":0.9,"unit":"fraction","basis":"judgment","rationale":"Residence share of modeled health beneficiaries, not headquarters or spending share. Judgment; no global benefit is relabeled as U.S. benefit.","sourceIds":[]},{"name":"delayYears","value":10.5,"unit":"years","basis":"judgment","rationale":"Time to realization, not duration of the benefit. Clinical central uses the BIO historical 10.5-year Phase-I-to-approval average as a proxy; energy uses an explicit ten-year construction/rollout judgment.","sourceIds":["bio-2011-2020"]},{"name":"discountRate","value":0.03,"unit":"fraction","basis":"judgment","rationale":"3% annual discount convention; judgment, not an observed organizational performance parameter.","sourceIds":[]},{"name":"costUSD","value":3597698,"unit":"USD/year","basis":"observed","rationale":"Latest inspected original 2024 charity expense, used as an annual accounting comparator; not a current marginal funding offer.","sourceIds":["irs2024"]},{"name":"Annual-cost versus marginal-gift boundary","value":1,"unit":"fundingAdditionality factor","basis":"judgment","sourceIds":[],"rationale":"Full annual expenses estimate annual-work contribution, not return from an extra donation. Unknown marginal funding capacity remains a reservation; old haircuts retained only as sensitivities."},{"name":"Income pathway central","value":"[{\"editionShare\":1,\"independentShare\":1,\"discountRate\":0.03,\"people\":5000,\"annualIncomeBeforeUSD\":40000,\"annualIncomeGainUSD\":20000,\"years\":5,\"delayYears\":3,\"causalFactors\":{\"implementationProbability\":0.25,\"organizationAttribution\":0.1,\"fundingAdditionality\":1},\"causalShare\":0.025},{\"editionShare\":1,\"independentShare\":1,\"discountRate\":0.03,\"people\":500,\"annualIncomeBeforeUSD\":75000,\"annualIncomeGainUSD\":-1000,\"years\":5,\"delayYears\":3,\"causalFactors\":{\"implementationProbability\":0.25,\"organizationAttribution\":0.1,\"fundingAdditionality\":1},\"causalShare\":0.025}]","unit":"people, real USD, years and conditional causal factors","basis":"judgment","sourceIds":["income-cg","income-evidence-1","income-evidence-2","income-evidence-3","income-evidence-4"],"rationale":"All numerical scenario values below are explicit hypotheses, not empirically measured IFP effects. Central cohort 5,000 is a finite policy-scale prior below cited talent pools, not an observed supported cohort. $40k counterfactual and $20k real annual gain represent disposable purchasing-power income after tax, higher housing and migration costs, and outside-option earnings; they must be elicited from an actual affected cohort. Native savings: null"},{"name":"Income pathway low","value":"[{\"editionShare\":1,\"independentShare\":1,\"discountRate\":0.03,\"people\":500,\"annualIncomeBeforeUSD\":60000,\"annualIncomeGainUSD\":5000,\"years\":2,\"delayYears\":5,\"causalFactors\":{\"implementationProbability\":0.1,\"organizationAttribution\":0.03,\"fundingAdditionality\":1},\"causalShare\":0.003},{\"editionShare\":1,\"independentShare\":1,\"discountRate\":0.03,\"people\":500,\"annualIncomeBeforeUSD\":60000,\"annualIncomeGainUSD\":-1000,\"years\":2,\"delayYears\":5,\"causalFactors\":{\"implementationProbability\":0.1,\"organizationAttribution\":0.03,\"fundingAdditionality\":1},\"causalShare\":0.003}]","unit":"people, real USD, years and conditional causal factors","basis":"judgment","sourceIds":["income-cg","income-evidence-1","income-evidence-2","income-evidence-3","income-evidence-4"],"rationale":"All numerical scenario values below are explicit hypotheses, not empirically measured IFP effects. Central cohort 5,000 is a finite policy-scale prior below cited talent pools, not an observed supported cohort. $40k counterfactual and $20k real annual gain represent disposable purchasing-power income after tax, higher housing and migration costs, and outside-option earnings; they must be elicited from an actual affected cohort. Native savings: null"},{"name":"Income pathway high","value":"[{\"editionShare\":1,\"independentShare\":1,\"discountRate\":0.03,\"people\":14000,\"annualIncomeBeforeUSD\":30000,\"annualIncomeGainUSD\":40000,\"years\":10,\"delayYears\":1,\"causalFactors\":{\"implementationProbability\":0.5,\"organizationAttribution\":0.2,\"fundingAdditionality\":1},\"causalShare\":0.1},{\"editionShare\":1,\"independentShare\":1,\"discountRate\":0.03,\"people\":2000,\"annualIncomeBeforeUSD\":75000,\"annualIncomeGainUSD\":-2000,\"years\":10,\"delayYears\":1,\"causalFactors\":{\"implementationProbability\":0.5,\"organizationAttribution\":0.2,\"fundingAdditionality\":1},\"causalShare\":0.1}]","unit":"people, real USD, years and conditional causal factors","basis":"judgment","sourceIds":["income-cg","income-evidence-1","income-evidence-2","income-evidence-3","income-evidence-4"],"rationale":"All numerical scenario values below are explicit hypotheses, not empirically measured IFP effects. Central cohort 5,000 is a finite policy-scale prior below cited talent pools, not an observed supported cohort. $40k counterfactual and $20k real annual gain represent disposable purchasing-power income after tax, higher housing and migration costs, and outside-option earnings; they must be elicited from an actual affected cohort. Native savings: null"}],"scenarios":[{"id":"historical-alpha-central","label":"Initial estimate — diagnostic comparison, superseded","costUSD":3079238,"allPopulationQalys":9.375,"editionQalys":8.4375,"assumptions":"100000*.1*.5*.25*.1*.15*.5*.9 = 8.4375 U.S. QALYs."},{"id":"zero","label":"No additional useful clinical progress","costUSD":3597698,"allPopulationQalys":0,"editionQalys":0,"assumptions":"Existing funding or other organizations produce the same outcome."},{"id":"adverse","label":"Weaker evidence or harmful implementation","costUSD":3597698,"allPopulationQalys":-10,"editionQalys":-9,"assumptions":"Illustrative negative outcome, not an empirical harm estimate."},{"id":"health-only-previous-review","label":"Previous health-only review, superseded diagnostic","costUSD":3597698,"allPopulationQalys":0.4525080006568672,"editionQalys":0.4072572005911805,"assumptions":"{\"patients\":100000,\"annualQalyGain\":0.1,\"earlierYears\":0.25,\"reformProbability\":0.25,\"approvalProbability\":0.079,\"incrementalBenefitProbability\":0.5,\"organizationAttribution\":0.1,\"fundingAdditionality\":0.25,\"usShare\":0.9,\"delayYears\":10.5,\"discountRate\":0.03,\"costUSD\":3597698}"},{"id":"central","label":"Combined health and income central hypothesis","costUSD":3597698,"allPopulationQalys":1.8100320026274688,"editionQalys":1.629028802364722,"incomePathways":[{"editionShare":1,"independentShare":1,"discountRate":0.03,"people":5000,"annualIncomeBeforeUSD":40000,"annualIncomeGainUSD":20000,"years":5,"delayYears":3,"causalFactors":{"implementationProbability":0.25,"organizationAttribution":0.1,"fundingAdditionality":1},"causalShare":0.025,"sourceIds":["income-cg","income-evidence-1","income-evidence-2","income-evidence-3","income-evidence-4"],"rationale":"All numerical scenario values below are explicit hypotheses, not empirically measured IFP effects. Central cohort 5,000 is a finite policy-scale prior below cited talent pools, not an observed supported cohort. $40k counterfactual and $20k real annual gain represent disposable purchasing-power income after tax, higher housing and migration costs, and outside-option earnings; they must be elicited from an actual affected cohort. Direct migrant income excludes innovations, patents, GDP and clinical benefits. Income gains among the same persons can coexist with health gains only if no QALY valuation already incorporates income. Do not add IFP clinical-trial savings also assigned to 1Day.","counterfactual":"Only workers who otherwise leave/never enter count; people merely changing visa class while staying do not. Alternative Canada/UK earnings can sharply reduce income gain. No new donation credit for historic USCIS reforms."},{"editionShare":1,"independentShare":1,"discountRate":0.03,"people":500,"annualIncomeBeforeUSD":75000,"annualIncomeGainUSD":-1000,"years":5,"delayYears":3,"causalFactors":{"implementationProbability":0.25,"organizationAttribution":0.1,"fundingAdditionality":1},"causalShare":0.025,"sourceIds":["income-cg","income-evidence-1","income-evidence-2","income-evidence-3","income-evidence-4"],"rationale":"All numerical scenario values below are explicit hypotheses, not empirically measured IFP effects. Central cohort 5,000 is a finite policy-scale prior below cited talent pools, not an observed supported cohort. $40k counterfactual and $20k real annual gain represent disposable purchasing-power income after tax, higher housing and migration costs, and outside-option earnings; they must be elicited from an actual affected cohort. Direct migrant income excludes innovations, patents, GDP and clinical benefits. Income gains among the same persons can coexist with health gains only if no QALY valuation already incorporates income. Do not add IFP clinical-trial savings also assigned to 1Day.","counterfactual":"Only workers who otherwise leave/never enter count; people merely changing visa class while staying do not. Alternative Canada/UK earnings can sharply reduce income gain. No new donation credit for historic USCIS reforms."}],"assumptions":"Annual-cost comparison; fundingAdditionality=1. Health vector: {\"patients\":100000,\"annualQalyGain\":0.1,\"earlierYears\":0.25,\"reformProbability\":0.25,\"approvalProbability\":0.079,\"incrementalBenefitProbability\":0.5,\"organizationAttribution\":0.1,\"fundingAdditionality\":1,\"usShare\":0.9,\"delayYears\":10.5,\"discountRate\":0.03,\"costUSD\":3597698}. Income paths are explicit hypotheses, discounted separately; not confidence limits. Second cohort explicitly subtracts illustrative local wage/competition losses using signed log income. Numbers are stress assumptions; housing pressure, public-service costs, origin-country brain drain and family disruption remain unmeasured. For a USA estimate origin-country welfare is outside geography but should be disclosed."},{"id":"low","label":"Conservative joint hypothesis","costUSD":3597698,"allPopulationQalys":0.0010029092928073712,"editionQalys":0.000802327434245897,"incomePathways":[{"editionShare":1,"independentShare":1,"discountRate":0.03,"people":500,"annualIncomeBeforeUSD":60000,"annualIncomeGainUSD":5000,"years":2,"delayYears":5,"causalFactors":{"implementationProbability":0.1,"organizationAttribution":0.03,"fundingAdditionality":1},"causalShare":0.003,"sourceIds":["income-cg","income-evidence-1","income-evidence-2","income-evidence-3","income-evidence-4"],"rationale":"All numerical scenario values below are explicit hypotheses, not empirically measured IFP effects. Central cohort 5,000 is a finite policy-scale prior below cited talent pools, not an observed supported cohort. $40k counterfactual and $20k real annual gain represent disposable purchasing-power income after tax, higher housing and migration costs, and outside-option earnings; they must be elicited from an actual affected cohort. Direct migrant income excludes innovations, patents, GDP and clinical benefits. Income gains among the same persons can coexist with health gains only if no QALY valuation already incorporates income. Do not add IFP clinical-trial savings also assigned to 1Day.","counterfactual":"Only workers who otherwise leave/never enter count; people merely changing visa class while staying do not. Alternative Canada/UK earnings can sharply reduce income gain. No new donation credit for historic USCIS reforms."},{"editionShare":1,"independentShare":1,"discountRate":0.03,"people":500,"annualIncomeBeforeUSD":60000,"annualIncomeGainUSD":-1000,"years":2,"delayYears":5,"causalFactors":{"implementationProbability":0.1,"organizationAttribution":0.03,"fundingAdditionality":1},"causalShare":0.003,"sourceIds":["income-cg","income-evidence-1","income-evidence-2","income-evidence-3","income-evidence-4"],"rationale":"All numerical scenario values below are explicit hypotheses, not empirically measured IFP effects. Central cohort 5,000 is a finite policy-scale prior below cited talent pools, not an observed supported cohort. $40k counterfactual and $20k real annual gain represent disposable purchasing-power income after tax, higher housing and migration costs, and outside-option earnings; they must be elicited from an actual affected cohort. Direct migrant income excludes innovations, patents, GDP and clinical benefits. Income gains among the same persons can coexist with health gains only if no QALY valuation already incorporates income. Do not add IFP clinical-trial savings also assigned to 1Day.","counterfactual":"Only workers who otherwise leave/never enter count; people merely changing visa class while staying do not. Alternative Canada/UK earnings can sharply reduce income gain. No new donation credit for historic USCIS reforms."}],"assumptions":"Annual-cost comparison; fundingAdditionality=1. Health vector: {\"patients\":10000,\"annualQalyGain\":0.05,\"earlierYears\":0.08333333333333333,\"reformProbability\":0.1,\"approvalProbability\":0.05,\"incrementalBenefitProbability\":0.25,\"organizationAttribution\":0.03,\"fundingAdditionality\":1,\"usShare\":0.8,\"delayYears\":15,\"discountRate\":0.03,\"costUSD\":3597698}. Income paths are explicit hypotheses, discounted separately; not confidence limits. Second cohort explicitly subtracts illustrative local wage/competition losses using signed log income. Numbers are stress assumptions; housing pressure, public-service costs, origin-country brain drain and family disruption remain unmeasured. For a USA estimate origin-country welfare is outside geography but should be disclosed."},{"id":"high","label":"Favorable joint hypothesis","costUSD":3597698,"allPopulationQalys":363.9130809120692,"editionQalys":327.5217728208623,"incomePathways":[{"editionShare":1,"independentShare":1,"discountRate":0.03,"people":14000,"annualIncomeBeforeUSD":30000,"annualIncomeGainUSD":40000,"years":10,"delayYears":1,"causalFactors":{"implementationProbability":0.5,"organizationAttribution":0.2,"fundingAdditionality":1},"causalShare":0.1,"sourceIds":["income-cg","income-evidence-1","income-evidence-2","income-evidence-3","income-evidence-4"],"rationale":"All numerical scenario values below are explicit hypotheses, not empirically measured IFP effects. Central cohort 5,000 is a finite policy-scale prior below cited talent pools, not an observed supported cohort. $40k counterfactual and $20k real annual gain represent disposable purchasing-power income after tax, higher housing and migration costs, and outside-option earnings; they must be elicited from an actual affected cohort. Direct migrant income excludes innovations, patents, GDP and clinical benefits. Income gains among the same persons can coexist with health gains only if no QALY valuation already incorporates income. Do not add IFP clinical-trial savings also assigned to 1Day.","counterfactual":"Only workers who otherwise leave/never enter count; people merely changing visa class while staying do not. Alternative Canada/UK earnings can sharply reduce income gain. No new donation credit for historic USCIS reforms."},{"editionShare":1,"independentShare":1,"discountRate":0.03,"people":2000,"annualIncomeBeforeUSD":75000,"annualIncomeGainUSD":-2000,"years":10,"delayYears":1,"causalFactors":{"implementationProbability":0.5,"organizationAttribution":0.2,"fundingAdditionality":1},"causalShare":0.1,"sourceIds":["income-cg","income-evidence-1","income-evidence-2","income-evidence-3","income-evidence-4"],"rationale":"All numerical scenario values below are explicit hypotheses, not empirically measured IFP effects. Central cohort 5,000 is a finite policy-scale prior below cited talent pools, not an observed supported cohort. $40k counterfactual and $20k real annual gain represent disposable purchasing-power income after tax, higher housing and migration costs, and outside-option earnings; they must be elicited from an actual affected cohort. Direct migrant income excludes innovations, patents, GDP and clinical benefits. Income gains among the same persons can coexist with health gains only if no QALY valuation already incorporates income. Do not add IFP clinical-trial savings also assigned to 1Day.","counterfactual":"Only workers who otherwise leave/never enter count; people merely changing visa class while staying do not. Alternative Canada/UK earnings can sharply reduce income gain. No new donation credit for historic USCIS reforms."}],"assumptions":"Annual-cost comparison; fundingAdditionality=1. Health vector: {\"patients\":500000,\"annualQalyGain\":0.15,\"earlierYears\":0.5,\"reformProbability\":0.5,\"approvalProbability\":0.15,\"incrementalBenefitProbability\":0.75,\"organizationAttribution\":0.2,\"fundingAdditionality\":1,\"usShare\":0.9,\"delayYears\":5,\"discountRate\":0.03,\"costUSD\":3597698}. Income paths are explicit hypotheses, discounted separately; not confidence limits. Second cohort explicitly subtracts illustrative local wage/competition losses using signed log income. Numbers are stress assumptions; housing pressure, public-service costs, origin-country brain drain and family disruption remain unmeasured. For a USA estimate origin-country welfare is outside geography but should be disclosed."},{"id":"three-year-funded-cycle","label":"Three annual budgets for the same effects","costUSD":10793094,"allPopulationQalys":1.8100320026274688,"editionQalys":1.629028802364722,"incomePathways":[{"editionShare":1,"independentShare":1,"discountRate":0.03,"people":5000,"annualIncomeBeforeUSD":40000,"annualIncomeGainUSD":20000,"years":5,"delayYears":3,"causalFactors":{"implementationProbability":0.25,"organizationAttribution":0.1,"fundingAdditionality":1},"causalShare":0.025,"sourceIds":["income-cg","income-evidence-1","income-evidence-2","income-evidence-3","income-evidence-4"],"rationale":"All numerical scenario values below are explicit hypotheses, not empirically measured IFP effects. Central cohort 5,000 is a finite policy-scale prior below cited talent pools, not an observed supported cohort. $40k counterfactual and $20k real annual gain represent disposable purchasing-power income after tax, higher housing and migration costs, and outside-option earnings; they must be elicited from an actual affected cohort. Direct migrant income excludes innovations, patents, GDP and clinical benefits. Income gains among the same persons can coexist with health gains only if no QALY valuation already incorporates income. Do not add IFP clinical-trial savings also assigned to 1Day.","counterfactual":"Only workers who otherwise leave/never enter count; people merely changing visa class while staying do not. Alternative Canada/UK earnings can sharply reduce income gain. No new donation credit for historic USCIS reforms."},{"editionShare":1,"independentShare":1,"discountRate":0.03,"people":500,"annualIncomeBeforeUSD":75000,"annualIncomeGainUSD":-1000,"years":5,"delayYears":3,"causalFactors":{"implementationProbability":0.25,"organizationAttribution":0.1,"fundingAdditionality":1},"causalShare":0.025,"sourceIds":["income-cg","income-evidence-1","income-evidence-2","income-evidence-3","income-evidence-4"],"rationale":"All numerical scenario values below are explicit hypotheses, not empirically measured IFP effects. Central cohort 5,000 is a finite policy-scale prior below cited talent pools, not an observed supported cohort. $40k counterfactual and $20k real annual gain represent disposable purchasing-power income after tax, higher housing and migration costs, and outside-option earnings; they must be elicited from an actual affected cohort. Direct migrant income excludes innovations, patents, GDP and clinical benefits. Income gains among the same persons can coexist with health gains only if no QALY valuation already incorporates income. Do not add IFP clinical-trial savings also assigned to 1Day.","counterfactual":"Only workers who otherwise leave/never enter count; people merely changing visa class while staying do not. Alternative Canada/UK earnings can sharply reduce income gain. No new donation credit for historic USCIS reforms."}],"assumptions":"Same health and income denominator but three years of charity expense, not three repeated copies of the benefits."},{"id":"no-income","label":"No independent economic benefit","costUSD":3597698,"allPopulationQalys":1.8100320026274688,"editionQalys":1.629028802364722,"incomePathways":[],"assumptions":"Same health model with zero independent economic effect; tests failure, not a claim that omitted evidence proves zero value."},{"id":"old-donor-haircut","label":"Prior marginal-funding haircut applied as sensitivity","costUSD":3597698,"allPopulationQalys":0.4525080006568672,"editionQalys":0.4072572005911805,"incomePathways":[{"editionShare":1,"independentShare":1,"discountRate":0.03,"people":5000,"annualIncomeBeforeUSD":40000,"annualIncomeGainUSD":20000,"years":5,"delayYears":3,"causalFactors":{"implementationProbability":0.25,"organizationAttribution":0.1,"fundingAdditionality":0.25},"causalShare":0.00625,"sourceIds":["income-cg","income-evidence-1","income-evidence-2","income-evidence-3","income-evidence-4"],"rationale":"All numerical scenario values below are explicit hypotheses, not empirically measured IFP effects. Central cohort 5,000 is a finite policy-scale prior below cited talent pools, not an observed supported cohort. $40k counterfactual and $20k real annual gain represent disposable purchasing-power income after tax, higher housing and migration costs, and outside-option earnings; they must be elicited from an actual affected cohort. Direct migrant income excludes innovations, patents, GDP and clinical benefits. Income gains among the same persons can coexist with health gains only if no QALY valuation already incorporates income. Do not add IFP clinical-trial savings also assigned to 1Day.","counterfactual":"Only workers who otherwise leave/never enter count; people merely changing visa class while staying do not. Alternative Canada/UK earnings can sharply reduce income gain. No new donation credit for historic USCIS reforms."},{"editionShare":1,"independentShare":1,"discountRate":0.03,"people":500,"annualIncomeBeforeUSD":75000,"annualIncomeGainUSD":-1000,"years":5,"delayYears":3,"causalFactors":{"implementationProbability":0.25,"organizationAttribution":0.1,"fundingAdditionality":0.25},"causalShare":0.00625,"sourceIds":["income-cg","income-evidence-1","income-evidence-2","income-evidence-3","income-evidence-4"],"rationale":"All numerical scenario values below are explicit hypotheses, not empirically measured IFP effects. Central cohort 5,000 is a finite policy-scale prior below cited talent pools, not an observed supported cohort. $40k counterfactual and $20k real annual gain represent disposable purchasing-power income after tax, higher housing and migration costs, and outside-option earnings; they must be elicited from an actual affected cohort. Direct migrant income excludes innovations, patents, GDP and clinical benefits. Income gains among the same persons can coexist with health gains only if no QALY valuation already incorporates income. Do not add IFP clinical-trial savings also assigned to 1Day.","counterfactual":"Only workers who otherwise leave/never enter count; people merely changing visa class while staying do not. Alternative Canada/UK earnings can sharply reduce income gain. No new donation credit for historic USCIS reforms."}],"assumptions":"Legacy funding factor 0.25 on both components; not the annual-cost central estimate or verified marginal gift return."}],"sensitivity":["Conservative joint case: $441.8M. Not a confidence limit.","Favorable joint case: $7K. Not a confidence limit.","No income: $22.1M.","Three annual budgets: $975K.","Legacy donor haircut: $1.3M. Not a measured marginal gift offer."],"missingInputs":["2026 operating budget, cash forecast, grant duration/payment schedule and remaining unrestricted funds","Clinical-policy workstream allocation and costed unfunded additional package","Independent IFP and marginal donor contribution to operational reform","Effective-care timing, affected treatments, incremental efficacy, patient uptake and U.S. residence","External development, regulator and treatment resource costs","Empirically estimated immigration income, climate and scientific-productivity effects net of displacement and overlap","Measured net disposable-income gains, incidence, causal scale and public-resource costs to replace income hypotheses"],"calibration":{"reviewed":"2026-09-30","kind":"clinical","previousCentral":{"costUSD":3079238,"allPopulationQalys":9.375,"editionQalys":8.4375,"pricePerBetterLife":3649467.2592592593},"scenarioInputs":{"central":{"patients":100000,"annualQalyGain":0.1,"earlierYears":0.25,"reformProbability":0.25,"approvalProbability":0.079,"incrementalBenefitProbability":0.5,"organizationAttribution":0.1,"fundingAdditionality":1,"usShare":0.9,"delayYears":10.5,"discountRate":0.03,"costUSD":3597698},"low":{"patients":10000,"annualQalyGain":0.05,"earlierYears":0.08333333333333333,"reformProbability":0.1,"approvalProbability":0.05,"incrementalBenefitProbability":0.25,"organizationAttribution":0.03,"fundingAdditionality":1,"usShare":0.8,"delayYears":15,"discountRate":0.03,"costUSD":3597698},"high":{"patients":500000,"annualQalyGain":0.15,"earlierYears":0.5,"reformProbability":0.5,"approvalProbability":0.15,"incrementalBenefitProbability":0.75,"organizationAttribution":0.2,"fundingAdditionality":1,"usShare":0.9,"delayYears":5,"discountRate":0.03,"costUSD":3597698}},"evidence":"docs/geography-discovery/usa-three-cost-calibration-2026-09-30.md","comparison":"Current headline includes signed income welfare and uses a consistent annual-cost counterfactual. Alpha and prior health-only results remain diagnostics.","previousHealthOnly":{"scenario":{"id":"central","label":"Recalibrated positive-health 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