{"version":"sf-hrtc-therapy-cea-v1","reviewedAt":"2026-09-07","organization":"Harm Reduction Therapy Center","program":"Modeled alcohol-focused course within Adult Mobile Behavioral Health","scope":"Proposed analytic five-session slice, not evidence HRTC implements the exact external HaRT-A protocol","confidence":"very-low","denominator":"10 incremental quality-adjusted life years","amountSemantics":"modeled marginal donor expenditure, not a verified funding offer","formula":"10 * costPerOfferedCourse / (physicalScoreGain * utilityPerPhysicalPoint * transferRetention * effectiveWeeks / 52 * additionality)","anchors":{"annualBudgetUsd":899823,"annualStaffHours":4530,"budgetedStaffHourUsd":198.64,"plannedUnduplicatedClients":500,"contractPeriod":"2024-07-01 through 2029-06-30","physicalEffectStandardized":0.41,"mappingPcsCoefficient":0.00781},"scenarios":[{"name":"Optimistic positive","costPerOfferedCourse":1000,"physicalScoreGain":6,"utilityPerPhysicalPoint":0.00781,"transferRetention":1,"effectiveWeeks":30,"additionality":0.75},{"name":"Central analyst estimate","costPerOfferedCourse":1500,"physicalScoreGain":4,"utilityPerPhysicalPoint":0.00781,"transferRetention":0.5,"effectiveWeeks":18,"additionality":0.5},{"name":"Pessimistic positive","costPerOfferedCourse":2500,"physicalScoreGain":1,"utilityPerPhysicalPoint":0.00781,"transferRetention":0.25,"effectiveWeeks":6,"additionality":0.25}],"judgments":[{"key":"costPerOfferedCourse","label":"Donor cost per offered course","basis":"Five one-hour sessions plus 2.5 hours of engagement, missed appointments and coordination at about $200/hour gives $1,500. Hours and rounding are assumptions. The published $198.64 is a budgeted service-resource benchmark; do not add a second blanket overhead allowance."},{"key":"physicalScoreGain","label":"Peak incremental SF-12 physical score","basis":"Four points is an analyst scenario, compatible in scale with a small-to-medium effect but not recovered from d=0.41. A normative standard deviation is not necessarily the trial's effect-size denominator."},{"key":"transferRetention","label":"Mapping and delivery transfer","basis":"50% jointly discounts protocol, retention/delivery and population differences, unvalidated change-score mapping and the earlier inconclusive quality-of-life trial. Not a measured causal adjustment."},{"key":"effectiveWeeks","label":"Full-effect-equivalent weeks","basis":"18 assumes a linear rise over 12 weeks and decline to zero over 24: 12/2 + 24/2. It credits incremental area under the curve, not persistent within-person improvement when usual care catches up."},{"key":"additionality","label":"Funding additionality","basis":"50% allows replacement of existing public/private financing or alternative treatment. The existing contract is not available philanthropic capacity."}],"mappingBoundary":"Hanmer's group-average SF-12 to SF-6D equation includes 0.00781 per physical component point. Applying it to changes assumes unchanged demographics and no mental-component change. The source did not validate change-score prediction. No QALYs were measured in the selected HaRT-A trial.","nullBoundary":"No incremental utility improvement or no additional funded treatment means no finite price. Positive scenarios are not confidence intervals; harms are possible and would require a signed net-benefit model.","fundingRoom":{"verifiedUsd":null,"status":"unverified","nextEvidence":"Participant-linked course offers, dose and utility follow-up plus incremental staffing and public-versus-private funding plan; no contact has been made."},"excluded":["Medication and naloxone effects","Overdose mortality or other survival gains","Separate alcohol, depression, employment or housing benefits overlapping the mapped utility","Broader youth and training programs","Public-payer savings"],"sources":[{"publisher":"SF Health Commission","title":"November 2024 contract report, printed page 5","url":"https://media.api.sf.gov/documents/HC_Monthly_November_Report_FINAL_0.pdf","published":"2024-11-05","retrieved":"2026-09-07","sourceType":"Adult Mobile Behavioral Health budgeted hours and clients; not marginal course cost"},{"publisher":"Harm Reduction Therapy Center","title":"Mission Mobile team and Gubbio","url":"https://harmreductiontherapy.org/news/may-2025-newsletter-the-mission-mobile-team-moves-one-chair-inside-gubbio/","published":"2025-05","retrieved":"2026-09-07","sourceType":"Local delivery description, not causal outcomes"},{"publisher":"Collins et al.","title":"Combining extended-release naltrexone and behavioral harm-reduction treatment: randomized clinical trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC9875110/","published":"2021","retrieved":"2026-09-07","sourceType":"HaRT-A alone comparison only; physical quality of life, not measured QALYs"},{"publisher":"Collins et al.","title":"Randomized controlled trial of harm reduction treatment for alcohol","url":"https://depts.washington.edu/harrtlab/wordpress/wp-content/uploads/2019/03/Collins-et-al-2019-harta.pdf","published":"2019","retrieved":"2026-09-07","sourceType":"Earlier four-session trial; inconclusive quality-of-life effect"},{"publisher":"Hanmer, Value in Health","title":"Predicting an SF-6D Preference-Based Score Using MCS and PCS Scores from the SF-12 or SF-36","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC4000703/","published":"2009","retrieved":"2026-09-07","sourceType":"Group-average mapping; change-score validity not established"}],"evaluatedScenarios":[{"name":"Optimistic positive","costPerOfferedCourse":1000,"physicalScoreGain":6,"utilityPerPhysicalPoint":0.00781,"transferRetention":1,"effectiveWeeks":30,"additionality":0.75,"mappedPeakUtility":0.04686,"qalysPerOfferedCourse":0.020275961538461538,"fundedCourses":100,"additionalQalys":2.027596153846154,"costPerTenQalys":493194.8593920425},{"name":"Central analyst estimate","costPerOfferedCourse":1500,"physicalScoreGain":4,"utilityPerPhysicalPoint":0.00781,"transferRetention":0.5,"effectiveWeeks":18,"additionality":0.5,"mappedPeakUtility":0.03124,"qalysPerOfferedCourse":0.0027034615384615387,"fundedCourses":66.66666666666667,"additionalQalys":0.18023076923076925,"costPerTenQalys":5548442.168160478},{"name":"Pessimistic positive","costPerOfferedCourse":2500,"physicalScoreGain":1,"utilityPerPhysicalPoint":0.00781,"transferRetention":0.25,"effectiveWeeks":6,"additionality":0.25,"mappedPeakUtility":0.00781,"qalysPerOfferedCourse":0.00005632211538461538,"fundedCourses":40,"additionalQalys":0.0022528846153846154,"costPerTenQalys":443875373.45283824}]}