{"path":"docs/open-botec/estimates/us-ca-san-francisco/sfaf-naloxone.json","schemaVersion":"open-botec/0.1","id":"slug:sf-aids-foundation/naloxone-outreach/naloxone-distribution/us-ca-san-francisco/2025/v1","key":{"org":{"name":"San Francisco AIDS Foundation","orgId":"slug:sf-aids-foundation","ein":null},"program":{"slug":"naloxone-outreach","name":"Additional targeted overdose-prevention outreach and naloxone distribution"},"geography":{"geoId":"us-ca-san-francisco","name":"San Francisco, California","beneficiaryBasis":"service-location"},"year":2025,"modelVersion":"v1","archetypeId":"naloxone-distribution"},"status":{"tier":"draft","since":"2026-10-18","confidence":"very-low"},"template":{"archetypeId":"naloxone-distribution","templateVersion":"v1","parameterSets":["parameters/us-ca-san-francisco/naloxone-distribution.json"],"overrides":[]},"scope":{"counterfactual":"Existing SF public naloxone supply and other distributors continue; the gift funds additional outreach doses.","excluded":["Nonfatal brain injury","Family benefits","Treatment navigation"]},"inputs":{"utility":{"label":"Health utility of survivors","value":{"p10":0.6,"p50":0.7,"p90":0.8,"shape":"two-piece-logit","basis":"analyst-scenarios"},"scope":"universal","basis":"transferred","rationale":"Downward transfer from 0.799 for HIV-negative daily heroin injection, allowing comorbidity and population differences.","sources":[{"publisher":"Patton et al., Quality of Life Research","title":"Analyzing quality of life among people with opioid use disorder from the NIDA Data Share initiative","url":"https://link.springer.com/article/10.1007/s11136-024-03729-6","published":"2024-08-08","retrieved":"2026-09-07"}],"from":"templates/naloxone-distribution.v1.json"},"annualHazard":{"label":"Annual all-cause mortality hazard after a nonfatal overdose","value":{"p10":0.055,"p50":0.08,"p90":0.15,"shape":"two-piece-lognormal","basis":"analyst-scenarios"},"scope":"universal","basis":"transferred","rationale":"Central informed by 778.3 deaths per 10,000 person-years in a US overdose-survivor cohort. Note: a higher hazard lowers QALYs, so p90 here is the pessimistic case.","sources":[{"publisher":"Olfson et al., JAMA Psychiatry","title":"Causes of Death After Nonfatal Opioid Overdose","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC6143082/","published":"2018","retrieved":"2026-09-07"},{"publisher":"Weiner et al., Annals of Emergency Medicine","title":"One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose","url":"https://pubmed.ncbi.nlm.nih.gov/31229387/","published":"2020","retrieved":"2026-09-07"}],"from":"templates/naloxone-distribution.v1.json"},"horizonYears":{"label":"Credited survival horizon","value":{"p10":10,"p50":15,"p90":20,"shape":"two-piece-lognormal","basis":"analyst-scenarios"},"scope":"convention","basis":"judgment","rationale":"Truncates benefits because recipient ages and long-term outcomes are unknown; not a life expectancy.","from":"templates/naloxone-distribution.v1.json"},"discountRate":{"label":"Annual QALY discount rate","value":{"p10":0.03,"p50":0.03,"p90":0.03,"shape":"fixed","basis":"convention"},"scope":"convention","basis":"convention","rationale":"Project-wide 3% convention.","from":"templates/naloxone-distribution.v1.json"},"costPerDose":{"label":"Donor cost per additional dose delivered","value":{"p10":10,"p50":20,"p90":40,"shape":"two-piece-lognormal","basis":"analyst-scenarios"},"scope":"local","basis":"judgment","rationale":"About 2x the $9.61 planned bundle/target-dose benchmark, rounded, allowing extra outreach effort and delivery shortfalls. Not an SFAF quote.","sources":[{"publisher":"SF Health Commission","title":"Proposed SFAF agreement 1000032060","url":"https://www.sf.gov/sites/default/files/2024-05/HC%20Memo%20Memo%20-%20%20SFAF%2032060%20Final.pdf","published":"2024-06-04","retrieved":"2026-09-07","locator":"$250,000 annual budget, 26,016 target doses = $9.61 per target dose"}],"from":"parameters/us-ca-san-francisco/naloxone-distribution.json"},"marginalYieldRetention":{"label":"Share of reported reversal yield retained at the margin","value":{"p10":0.25,"p50":0.5,"p90":0.75,"shape":"two-piece-logit","basis":"analyst-scenarios"},"scope":"local","basis":"judgment","rationale":"Aggregate judgment for harder-to-reach expansion, displacement, reporting mismatch and repeat recipients in a heavily supplied SF market.","from":"parameters/us-ca-san-francisco/naloxone-distribution.json"},"additionalSurvivalPerReversal":{"label":"Additional acute survivals per retained reversal","value":{"p10":0.005,"p50":0.02,"p90":0.05,"shape":"two-piece-logit","basis":"analyst-scenarios"},"scope":"local","basis":"judgment","rationale":"Credits one additional acute survivor per 50 retained reported reversals; spontaneous survival and alternative rescue are common in SF.","from":"parameters/us-ca-san-francisco/naloxone-distribution.json"},"reportedReversals":{"label":"Reversals reported by the organization in the reference year","value":{"p10":2852,"p50":2852,"p90":2852,"shape":"fixed","basis":"convention"},"scope":"org","basis":"observed","sources":[{"publisher":"San Francisco AIDS Foundation","title":"Overdose prevention and response; 2025 service reporting","url":"https://www.sfaf.org/health-services/overdose-prevention-response/","retrieved":"2026-09-07","locator":"2,852 reversals reported, 2025"}],"from":"estimates/us-ca-san-francisco/sfaf-naloxone.recipe.json"},"reportedDoses":{"label":"Doses distributed by the organization in the same year","value":{"p10":41399,"p50":41399,"p90":41399,"shape":"fixed","basis":"convention"},"scope":"org","basis":"observed","sources":[{"publisher":"San Francisco AIDS Foundation","title":"Overdose prevention and response; 2025 service reporting","url":"https://www.sfaf.org/health-services/overdose-prevention-response/","retrieved":"2026-09-07","locator":"41,399 doses distributed, 2025"}],"from":"estimates/us-ca-san-francisco/sfaf-naloxone.recipe.json"}},"nativeOutcome":{"unit":"additional opioid-overdose deaths averted","perUnitCost":"additional naloxone dose distributed","outcomesPer10kUsd":{"p10":0.06049,"p50":0.2941,"p90":1.122,"unit":"additional opioid-overdose deaths averted per $10,000","shape":"empirical","basis":"simulated"},"costPerOutcome":{"p10":8914,"p50":34010,"p90":165400,"unit":"USD per additional opioid-overdose deaths averted","shape":"empirical","basis":"simulated"},"centralPoint":29030,"formula":"reversalsPerDose * marginalYieldRetention * additionalSurvivalPerReversal"},"cost":{"currency":"USD","priceYear":2025,"boundary":"unit-cost-judgment"},"qalyLayer":{"bridgeId":"opioid-death-averted-to-qaly","bridgeVersion":"v1","qalysPerNativeOutcome":{"p10":3.325,"p50":4.8,"p90":6.357,"unit":"QALYs per additional opioid-overdose deaths averted","shape":"empirical","basis":"simulated"},"pricePer10Qalys":{"p10":18570,"p50":73390,"p90":362400,"unit":"USD per 10 QALYs","shape":"empirical","basis":"simulated"},"centralPointPricePer10Qalys":56330,"probabilityNonPositive":0,"auditStatus":"unaudited","notes":"probabilityNonPositive is 0 by construction: v1 input distributions are strictly positive, so the null case lives only in nullBoundary."},"simulation":{"method":"monte-carlo-independent","samples":20000,"seed":20261018,"tool":"docs/open-botec/tools/evaluate.mjs","notes":"Inputs drawn independently. Legacy SF scenarios were joint corners; independent draws give a narrower price spread than those corners."},"margin":{"basis":"average-adjusted-to-marginal","adjustments":["marginalYieldRetention"]},"fundingRoom":{"status":"unverified","nextEvidence":"Current additional outreach plan, executed costs, unmet coverage and recipient-linked rescue records."},"nullBoundary":"If the gift replaces existing provision or reaches no otherwise-fatal events, deaths averted are zero and there is no finite price.","provenance":{"sessions":[{"sessionId":"legacy-unrecorded","workerId":"unknown","role":"author","startedAt":null,"endedAt":null,"model":null,"evidence":"Legacy model data/san-francisco/sfaf-naloxone-cea-v1.json; interval not recorded in data/research-effort.json. Factoring into this template: open-botec design session 2026-10-18."}],"audits":[]},"conflictOfInterest":{"declared":false,"authorRelationship":"none","selfSubmitted":false},"links":{"legacyModel":"data/san-francisco/sfaf-naloxone-cea-v1.json"}}