{"version":"sf-rams-depression-cea-v1","reviewedAt":"2026-09-07","organization":"Richmond Area Multi-Services (RAMS)","program":"Modeled adult depression-counseling course","confidence":"very-low","denominator":"10 incremental QALYs","formula":"10 * costPerOfferedCourse / (referenceQalys * transferRetention * additionality)","scope":"Hypothetical 15-contact depression-counseling course within Adult Outpatient; not an existing standardized RAMS CBT protocol, the whole clinic, or residential services.","scenarios":[{"name":"Favorable positive","costPerOfferedCourse":2000,"referenceQalys":0.099,"transferRetention":0.75,"additionality":0.75},{"name":"Central analyst estimate","costPerOfferedCourse":3000,"referenceQalys":0.057,"transferRetention":0.25,"additionality":0.5},{"name":"Unfavorable positive","costPerOfferedCourse":6000,"referenceQalys":0.015,"transferRetention":0.1,"additionality":0.25}],"judgments":[{"key":"costPerOfferedCourse","label":"Marginal course allowance","basis":"Assumed fifteen contacts at $150 loaded delivery each, plus $750 intake, supervision and coordination = $3,000. Neither dose nor rate is a RAMS quote. Includes offered-course effort and noncompletion."},{"key":"referenceQalys","label":"External one-year QALY calibration","basis":"CoBalT imputed baseline-adjusted EQ-5D-3L area-under-curve difference .057, 95% CI .015–.099, CBT plus usual care versus usual care in antidepressant-resistant depression. Already integrates one year and offered-treatment outcomes. Not an endpoint utility or RAMS effect."},{"key":"transferRetention","label":"Modality and population transfer","basis":"25% judgment for a substantial mismatch: RAMS describes predominantly psychodynamic training, not CoBalT CBT fidelity. Severity, existing psychotherapy and local delivery also differ. This is not evidence that psychodynamic care has one-quarter CBT efficacy."},{"key":"additionality","label":"Additional funded care","basis":"50% judgment for funding replacement/reimbursement and genuinely added capacity. No verified donor-sized gap or restricted depression tranche."}],"nullBoundary":"Positive scenarios combine a trial interval with subjective local assumptions; they are not a RAMS confidence interval. Zero local benefit or added capacity means no finite positive-benefit price. Signed reference QALYs preserve possible harm. No unmeasured long-term benefit added.","fundingRoom":{"verifiedUsd":null,"status":"unverified","nextEvidence":"Actual depression subgroup and modality, contact schedule, loaded course quote, outpatient-only Appendix B and reimbursement/wait-list crosswalk."},"excluded":["Residential Broderick and API collaborative services","Additional years or routine completion multipliers applied to the integrated QALY estimate","Employment, family or healthcare savings","Psychodynamic trial gains divided linearly by sessions"],"sources":[{"publisher":"RAMS","title":"Adult Outpatient Services","url":"https://ramsinc.org/programs/clinical-counseling-services/adult-outpatient-services/","published":"Undated current page","retrieved":"2026-09-07","sourceType":"Counseling service identity; no standardized depression-course cost"},{"publisher":"RAMS","title":"Outpatient Clinical Practicum","url":"https://ramsinc.org/programs/rams-training-institute/outpatient-clinical-practicum/","published":"Undated current page","retrieved":"2026-09-07","sourceType":"Predominantly psychodynamic training; not verified CBT fidelity"},{"publisher":"San Francisco","title":"RAMS FY2023–24 funding summary","url":"https://media.api.sf.gov/documents/USE_RAMS_Funding_Summary_23-24_updated_4_16_24.pdf","published":"FY2023–24 summary; April 2024 file revision","retrieved":"2026-09-07","sourceType":"Mixed adult contract includes outpatient, residential and collaborative services; not marginal course cost"},{"publisher":"Wiles et al. / NIHR","title":"CoBalT economic results","url":"https://www.ncbi.nlm.nih.gov/books/NBK261987/","published":"2014-05","retrieved":"2026-09-07","sourceType":"469-person randomized trial; one-year imputed EQ-5D economic endpoint"},{"publisher":"Wiles et al. / NIHR","title":"CoBalT full report Table 64","url":"https://njl-admin.nihr.ac.uk/document/download/2002530","published":"2014-05","retrieved":"2026-09-07","sourceType":"Base-case .057 QALYs, CI .015–.099; not descriptive .053 estimate"},{"publisher":"Tavistock Adult Depression Study economic researchers","title":"Long-term psychoanalytic psychotherapy economic evaluation","url":"https://researchonline.lse.ac.uk/id/eprint/119292/1/1_s2.0_S0165032723005955_main.pdf","published":"2023-05-08 online","retrieved":"2026-09-07","sourceType":"Longer 60-session protocol and CORE-6D; triangulation, not a scaled course coefficient"}],"evaluatedScenarios":[{"name":"Favorable positive","costPerOfferedCourse":2000,"referenceQalys":0.099,"transferRetention":0.75,"additionality":0.75,"qalysPerOfferedCourse":0.05568750000000001,"costPerTenQalys":359147.0258136924,"additionalQalys":2.7843750000000003},{"name":"Central analyst estimate","costPerOfferedCourse":3000,"referenceQalys":0.057,"transferRetention":0.25,"additionality":0.5,"qalysPerOfferedCourse":0.007125,"costPerTenQalys":4210526.315789473,"additionalQalys":0.23750000000000002},{"name":"Unfavorable positive","costPerOfferedCourse":6000,"referenceQalys":0.015,"transferRetention":0.1,"additionality":0.25,"qalysPerOfferedCourse":0.000375,"costPerTenQalys":160000000,"additionalQalys":0.00625}]}