{"version":"sf-progress-crisis-cea-v1","reviewedAt":"2026-09-07","organization":"Progress Foundation","program":"Avenues two-week acute diversion episode","confidence":"very-low","denominator":"10 incremental QALYs","formula":"10 * costPerPlace / (utilityGain * effectiveYears * engagement * additionality)","scope":"Proposed extra Avenues crisis-residential episode versus otherwise-available hospital care; not a no-treatment counterfactual or longer-term housing.","scenarios":[{"name":"Favorable positive","costPerPlace":10000,"utilityGain":0.05,"effectiveYears":0.038356164383561646,"engagement":1,"additionality":0.75,"horizonYears":0.038356164383561646},{"name":"Subjective positive central","costPerPlace":15000,"utilityGain":0.02,"effectiveYears":0.038356164383561646,"engagement":1,"additionality":0.5,"horizonYears":0.038356164383561646},{"name":"Unfavorable positive","costPerPlace":25000,"utilityGain":0.002,"effectiveYears":0.038356164383561646,"engagement":1,"additionality":0.25,"horizonYears":0.038356164383561646}],"judgments":[{"key":"costPerPlace","label":"Current episode allowance","basis":"Assumed $15,000, not a quote or inflation-adjusted audited cost. FY2022–23 pooled ADU budget $6,431,386 / 584 estimated annual clients is about $11,013, but estimated clients may differ from episodes, includes four programs and is not marginal Avenues pricing."},{"key":"utilityGain","label":"Short-term health advantage over hospital","basis":"Subjective .02, not a trial estimate. Closest small randomized QALY comparison found no significant adjusted health difference. Null is at least as credible as this positive scenario; satisfaction is not utility."},{"key":"effectiveYears","label":"Benefit window","basis":"Fourteen days divided by 365. No persistent recovery, mortality or hospital-access gain is assumed."},{"key":"engagement","label":"Separate completion multiplier","basis":"One: utility already averages across episodes including transfer/failure. Hospital backup remains necessary."},{"key":"additionality","label":"New donor-funded capacity","basis":"50% judgment. Public contract funding and contingency may replace donor spending; actual unfunded safe capacity unverified."}],"nullBoundary":"The evidence-led comparator is no demonstrated incremental QALY gain versus hospital care. Null is at least as credible as the positive central scenario. No finite positive-benefit price at zero effect; negative utility preserves harm. These positive cases are not confidence limits.","fundingRoom":{"verifiedUsd":null,"status":"unverified","nextEvidence":"A current Avenues marginal episode quote, hospital-transfer and safety costs, public reimbursement ledger, and a credible incremental health or access counterfactual."},"excluded":["Government-payer hospital savings deducted from donor costs","Health benefits versus no treatment when hospital care is the comparator","Deaths prevented or benefits after the two-week episode","Dore urgent-care clinic, long-term residential care and housing"],"sources":[{"publisher":"Progress Foundation","title":"Programs — Avenues","url":"https://www.progressfoundation.org/programs/","published":"Undated current page","retrieved":"2026-09-07","sourceType":"Local program identity and average two-week stay"},{"publisher":"SF Budget and Legislative Analyst","title":"January 25, 2023 budget analysis","url":"https://sfgov.legistar.com/View.ashx?GUID=0FB53ED1-587F-4421-AF84-99C1D8D7D45E&ID=11592302&M=F","published":"2023-01-25","retrieved":"2026-09-07","sourceType":"Printed pp15–18 pooled ADU budget and estimated clients, not marginal price"},{"publisher":"Howard et al.","title":"Women's crisis houses compared with psychiatric wards","url":"https://doi.org/10.1192/bjp.bp.110.081083","published":"2010-08","retrieved":"2026-09-07","sourceType":"Small randomized pilot; incomplete follow-up and an inconsistent displayed adjusted QALY coefficient, not imported"},{"publisher":"Fenton et al.","title":"Cost and cost-effectiveness of hospital vs residential crisis care","url":"https://pubmed.ncbi.nlm.nih.gov/11926936/","published":"2002-04","retrieved":"2026-09-07","sourceType":"Government-payer cost comparison; symptom/community-day outcomes, not QALYs"},{"publisher":"Fenton et al.","title":"Randomized trial of general hospital and residential alternative care","url":"https://pubmed.ncbi.nlm.nih.gov/9545998/","published":"1998","retrieved":"2026-09-07","sourceType":"Transfers and non-entry into assigned treatment constrain extrapolation"}],"evaluatedScenarios":[{"name":"Favorable positive","costPerPlace":10000,"utilityGain":0.05,"effectiveYears":0.038356164383561646,"engagement":1,"additionality":0.75,"horizonYears":0.038356164383561646,"qalysPerPlace":0.001438356164383562,"costPerTenQalys":69523809.52380951,"additionalQalys":0.01438356164383562},{"name":"Subjective positive central","costPerPlace":15000,"utilityGain":0.02,"effectiveYears":0.038356164383561646,"engagement":1,"additionality":0.5,"horizonYears":0.038356164383561646,"qalysPerPlace":0.0003835616438356165,"costPerTenQalys":391071428.57142854,"additionalQalys":0.0025570776255707767},{"name":"Unfavorable positive","costPerPlace":25000,"utilityGain":0.002,"effectiveYears":0.038356164383561646,"engagement":1,"additionality":0.25,"horizonYears":0.038356164383561646,"qalysPerPlace":0.000019178082191780822,"costPerTenQalys":13035714285.714285,"additionalQalys":0.00007671232876712329}]}