{"path":"docs/open-botec/estimates/us-ca-san-francisco/ymca-sf-dpp.json","schemaVersion":"open-botec/0.1","id":"slug:ymca-greater-sf/diabetes-prevention/lifestyle-diabetes-prevention/us-ca-san-francisco/2026/v1","key":{"org":{"name":"YMCA of Greater San Francisco","orgId":"slug:ymca-greater-sf","ein":null},"program":{"slug":"diabetes-prevention","name":"Additional SF diabetes-prevention offers"},"geography":{"geoId":"us-ca-san-francisco","name":"San Francisco, California","beneficiaryBasis":"service-location"},"year":2026,"modelVersion":"v1","archetypeId":"lifestyle-diabetes-prevention"},"status":{"tier":"draft","since":"2026-10-18","confidence":"very-low"},"template":{"archetypeId":"lifestyle-diabetes-prevention","templateVersion":"v1","parameterSets":["parameters/us-ca-san-francisco/lifestyle-diabetes-prevention.json"],"overrides":[]},"scope":{"counterfactual":"Medi-Cal and SFHSS-funded cohorts continue; the gift funds additional adult cohorts."},"inputs":{"extraKg":{"label":"Additional weight loss versus offer-only control","value":{"p10":1.1,"p50":2.3,"p90":3.4,"shape":"two-piece-lognormal","basis":"analyst-scenarios"},"scope":"universal","basis":"transferred","rationale":"Randomized YMCA offer trial, with scenario spread.","sources":[{"publisher":"American Journal of Public Health","title":"Ackermann et al.: randomized YMCA offer trial","url":"https://pubmed.ncbi.nlm.nih.gov/26378828/","published":"2015-09-17","retrieved":"2026-09-07"}],"from":"templates/lifestyle-diabetes-prevention.v1.json"},"discountedRetentionYears":{"label":"Discounted years over which the weight difference persists","value":{"p10":0.48549,"p50":2.3713,"p90":4.58021,"shape":"two-piece-lognormal","basis":"analyst-scenarios"},"scope":"universal","basis":"derived","rationale":"Sum over years t of retention[t]/1.03^(t+0.5) for the SF retention profiles [0.25,0.25], [0.5,1,0.75,0.25] and [0.5,1,1,1,1,0.5]. Embeds the 3% discount convention; a v2 template should split persistence from discounting.","sources":[{"publisher":"Diabetes Care","title":"Kuo et al.: prospective NDPP cost and QALY analysis","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12178621/","published":"2024-11-20","retrieved":"2026-09-07"}],"from":"templates/lifestyle-diabetes-prevention.v1.json"},"utilityPerKg":{"label":"QALY weight gain per kg of weight loss per year","value":{"p10":0.0007,"p50":0.0014,"p90":0.002,"shape":"two-piece-lognormal","basis":"analyst-scenarios"},"scope":"universal","basis":"transferred","rationale":"Observational utility association.","sources":[{"publisher":"Obesity","title":"Ackermann et al.: weight change and health utility","url":"https://onlinelibrary.wiley.com/doi/10.1038/oby.2009.114","published":"2009","retrieved":"2026-09-07"}],"from":"templates/lifestyle-diabetes-prevention.v1.json"},"costPerParticipant":{"label":"Donor cost per additional enrolled participant","value":{"p10":200,"p50":600,"p90":1200,"shape":"two-piece-lognormal","basis":"analyst-scenarios"},"scope":"local","basis":"judgment","rationale":"Analyst allowance; not a YMCA quote.","from":"parameters/us-ca-san-francisco/lifestyle-diabetes-prevention.json"},"fundingAdditionality":{"label":"Share of donor-funded enrollment that would not otherwise be funded","value":{"p10":0.2,"p50":0.5,"p90":0.8,"shape":"two-piece-logit","basis":"analyst-scenarios"},"scope":"local","basis":"judgment","rationale":"Medi-Cal covers DPP and SF Health Service System already funds YMCA cohorts, so donor-funded seats partly displace payer-funded ones.","sources":[{"publisher":"DHCS","title":"Medi-Cal diabetes prevention benefit","url":"https://www.dhcs.ca.gov/services/medi-cal-resources/diabetes-prevention-program-diabetes-prevention-program/","retrieved":"2026-09-07"},{"publisher":"SF Health Service System","title":"YMCA partnership and existing funded cohorts","url":"https://sfhss.org/dpp","retrieved":"2026-09-07"}],"from":"parameters/us-ca-san-francisco/lifestyle-diabetes-prevention.json"},"transfer":{"label":"Retention of trial effect in the local population and provider","value":{"p10":0.25,"p50":0.75,"p90":1,"shape":"two-piece-logit","basis":"analyst-scenarios"},"scope":"local","basis":"judgment","rationale":"Retention of the YMCA trial effect for SF cohorts.","from":"parameters/us-ca-san-francisco/lifestyle-diabetes-prevention.json"}},"nativeOutcome":{"unit":"discounted kg-years of incremental weight loss","perUnitCost":"additional enrolled participant offer","outcomesPer10kUsd":{"p10":2.425,"p50":20.2,"p90":113.6,"unit":"discounted kg-years of incremental weight loss per $10,000","shape":"empirical","basis":"simulated"},"costPerOutcome":{"p10":88.08,"p50":495.2,"p90":4124,"unit":"USD per discounted kg-years of incremental weight loss","shape":"empirical","basis":"simulated"},"centralPoint":293.4,"formula":"fundingAdditionality * extraKg * transfer * discountedRetentionYears"},"cost":{"currency":"USD","priceYear":2026,"boundary":"unit-cost-judgment"},"qalyLayer":{"bridgeId":"weight-loss-kg-year-to-qaly","bridgeVersion":"v1","qalysPerNativeOutcome":{"p10":0.0006893,"p50":0.001395,"p90":0.001984,"unit":"QALYs per discounted kg-years of incremental weight loss","shape":"empirical","basis":"simulated"},"pricePer10Qalys":{"p10":649100,"p50":4000000,"p90":35650000,"unit":"USD per 10 QALYs","shape":"empirical","basis":"simulated"},"centralPointPricePer10Qalys":2095000,"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":"marginal","adjustments":["fundingAdditionality"]},"fundingRoom":{"status":"unverified","nextEvidence":"Verified unfunded cohort with per-participant budget."},"nullBoundary":"If the cohort would have been funded anyway or weight loss does not persist, benefit is 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/ymca-dpp-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/ymca-dpp-cea-v1.json"}}