{"oa":{"schemaVersion":1,"modelId":"oa-abnormal-fit-completed-pathway-v1","reviewDate":"2026-09-08","organization":{"name":"Operation Access","legalName":"Ambulatory Surgery Access Coalition dba Operation Access","ein":"94-3180356","website":"https://www.operationaccess.org/"},"status":"Publishable conditional research; not a recommendation, provider quote or verified marginal offer","intervention":{"description":"Marginal support for OA's existing matching, donated-specialist coordination, preparation, interpretation and follow-up for an uninsured SF adult aged 50–75 with abnormal FIT and clinically indicated colonoscopy.","unit":"One completed-pathway equivalent; spending on offered referrals that fail to complete is allocated into this completed-unit cost.","scope":"Conditioned on an SF abnormal-FIT pathway; not unrestricted organization-wide donation effectiveness.","geographicShareOfUnrestrictedDonation":null,"restrictedGiftAcceptance":null,"availableAdditionalSlots":null,"downstreamCancerTreatmentAccess":"Required for assumed treated-health gains but not verified for modeled marginal patient."},"formulas":{"netQalyPerPathway":"marginallyEnabledFraction * netQalyPerEnabledCompletion","donorUsdPer10Qaly":"10 * cashAllocationPerCompletedPathway / netQalyPerPathway, only when netQalyPerPathway > 0","expandedCost":"cashAllocationPerCompletedPathway + marginallyEnabledFraction * (clinicalResourceSensitivityPerEnabledCompletion + otherDonatedSupportSensitivityPerEnabledCompletion)","expandedUsdPer10Qaly":"10 * expandedCost / netQalyPerPathway, only when netQalyPerPathway > 0","thresholdNetQalyPerEnabledCompletion":"cashAllocationPerCompletedPathway / (10000 * marginallyEnabledFraction), only when marginallyEnabledFraction > 0"},"observedCostAnchors":{"year":2025,"totalAccrualExpense":22876888,"donatedClinicalCharges":20530000,"otherDonatedSupport":89922,"cashLikeExpenseBySubtraction":2256966,"annualReportCashExpense":2256967,"cashPresentationDifference":1,"mixedCompletedServices":1529,"gastroenterologyServicesNotFitOnly":575,"derivedCashPerMixedCompletedService":1476.1059516023545,"programCashLikeExpense":1884605,"programCashPerMixedCompletedService":1232.573577501635,"budget2026CashExpense":1900000,"budgetPerPriorYearVolumeNotObserved2026Cost":1242.6422498364943},"externalEvidence":{"navigation":{"primaryUrl":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13007779/","analysisN":967,"randomizedN":985,"interventionCompletion":0.551,"comparatorCompletion":0.421,"riskDifference":0.13,"riskDifferenceCi95":[0.065,0.194],"usedAsModelMultiplier":false,"reason":"Offered navigation contrast differs from a completed OA pathway whose existing service already includes navigation."},"mortality":{"primaryUrl":"https://pubmed.ncbi.nlm.nih.gov/33789965/","horizonYears":10,"crcMortalityPer1000Compliers":6.8,"crcMortalityPer1000Noncompliers":16,"absoluteAssociation":0.0092,"causal":false,"population":"Veneto adults50–69, FIT>20microgramsHb/g; noncompliance means no colonoscopy within the program, not necessarily never scoped elsewhere.","timingBiasCaveat":"Exposure classification/timing and immortal-time bias have been raised in subsequent methodological critique; no claim these are solved.","methodologicalCritiqueUrl":"https://pubmed.ncbi.nlm.nih.gov/37549982/","discountedQalyPerDeathIllustration":10,"illustrativeAssociationQaly":0.092,"usedAsDirectCausalEffect":false}},"healthBridge":{"type":"Judgment-based aggregate net QALYs, informed but not estimated by external mortality evidence.","centralRationale":"0.05 net QALY is roughly half the illustrative observational 0.092 QALY association; it is not an estimated attenuation factor or a validated stage model.","mortalityMorbidityDecomposition":null,"reasonNoDecomposition":"No local stage, adenoma progression, utility or complication dataset supports a separate numeric decomposition. 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no confirmed restricted offer","partners":["Lions Eye Foundation / CPMC Lions Eye Clinic","CPMC ophthalmology clinicians and trainees","Pacific Vision Surgery Center"],"region":"SF clinical site and a conditionally SF-resident eligible cohort; the actual program also serves wider California and Nevada."},"status":"Constructed organization-specific conditional research estimate, not measured PVF effectiveness or a provider-priced offer","program":{"name":"Proposed additional first-eye cataract surgical access through shared PVF/Lions pathway","unit":"One eligible SF-resident patient assigned a supported first-eye surgical course; donor budget allocated across all assigned cases including failed referrals and noncompletion","coreHorizonYears":1,"coreCounterfactual":"Expedited surgery versus otherwise approximately one-year delay, not permanent denial","actualServiceVerified":true,"exactAdditionalDonorCourseVerified":false,"clinicalScope":"Visually significant first-eye cataract; clinical suitability, first/second-eye status, fellow-eye function and ocular comorbidity assessed by clinician","eligibility":"Model uninsured patients meeting current Lions rules; do not assume insured/Medi-Cal patients admitted under this particular pathway."},"funding":{"roomForFundingUsd":null,"verifiedRestrictedOffer":false,"cashSubsidyQuoteVerified":false,"additionalityDefinition":"Fraction of proposed complete surgical support actually expanded rather than replacing existing PVF/Lions/clinicalpartner financing; no effect on donation amount paid","counterfactual":"Existing Patient Assistance Fund, Lions funds, donated clinical capacity, ordinary referrals and any otherwise available coverage."},"costs":{"currency":"USD","priceYear":2026,"allAmountsJudgments":true,"centralDonorBudget":{"eligibilitySchedulingNavigationUsd":250,"incrementalFacilityConsumableSupportUsd":400,"postoperativeMedicationFollowupSupportUsd":200,"transportAccessContingencyUsd":150,"totalUsd":1000},"centralAdditionalPartnerResourceValueUsd":2500,"centralCompleteDirectResourcesUsd":3500,"interpretation":"$1,000 gift-funded cash plus $2,500 of assumed partner clinical, facility and lens resources not already included in cash. This allocation is a research judgment, not a quote, charge or procedure valuation. No empirical leverage factor is used. Actual partner commitments and unused capacity are unverified.","favorable":"$500 complete cash support and $2,500 total direct resources; leaner additional support with substantial clinical underwriting assumed.","pessimistic":"$2,000 cash support and $6,000 total direct resources; more support and higher delivery costs.","perspective":"Conditional donor cash; separate gross complete-direct-resource diagnostic. Not a net payer ICER or full societal cost. The complete-resource diagnostic retains the whole modeled course cost despite displacement; participant time and future medical costs are excluded."},"inputDefinitions":{"externalIntegratedQaly":"First-eye one-year trial assignment QALY difference: .056 centrally and favorably; .006, the trial's lower confidence-limit coordinate, for the pessimistic stress. This is not a local confidence interval. Already integrated: no extra one-year, onset, success or falls factor.","clinicalComparatorTransfer":"Judgment for local population, severity, comparator and pathway fit: .5 centrally and pessimistically, 1 favorably. Not a newly measured completion rate.","fundingAdditionality":"Judgment: .5 centrally, .75 favorably and .25 pessimistically. A separate financing contrast; set to 1 if the clinical contrast already directly compares a gift with no gift.","sharedIncrementalHarmQaly":"Extra local service harm outside the trial effect; scale only under identical replacement. Do not subtract trial complications again.","donorSpecificHarmQaly":"Net extra privacy, disruption or other harm caused by donor activity independently of added surgery; outside the funding factor."},"formulas":{"grossTransferredQaly":"externalIntegratedQaly * clinicalComparatorTransfer","netQalys":"fundingAdditionality * (grossTransferredQaly - sharedIncrementalHarmQaly) - donorSpecificHarmQaly","donorUsdPerTenQalys":"netQalys>0 ? 10*donorCashCostUsd/netQalys : null","directResourceDiagnosticUsdPerTenQalys":"netQalys>0 ? 10*completeDirectResourceCostUsd/netQalys : null","costCeiling":"10000 * netQalys; cost must be strictly below the ceiling to beat 100000 USD per 10 QALYs."},"coreScenarios":[{"id":"central","inputs":{"donorCashCostUsd":1000,"completeDirectResourceCostUsd":3500,"externalIntegratedQaly":0.056,"clinicalComparatorTransfer":0.5,"fundingAdditionality":0.5,"sharedIncrementalHarmQaly":0,"donorSpecificHarmQaly":0},"result":{"grossTransferredQaly":0.028,"netQalys":0.014,"donorUsdPerTenQalys":714285.7142857143,"directResourceDiagnosticUsdPerTenQalys":2500000,"donorCostCeilingAt100kPerTenQalys":140,"status":"positive conditional gain"}},{"id":"favorable","inputs":{"donorCashCostUsd":500,"completeDirectResourceCostUsd":2500,"externalIntegratedQaly":0.056,"clinicalComparatorTransfer":1,"fundingAdditionality":0.75,"sharedIncrementalHarmQaly":0,"donorSpecificHarmQaly":0},"result":{"grossTransferredQaly":0.056,"netQalys":0.042,"donorUsdPerTenQalys":119047.61904761904,"directResourceDiagnosticUsdPerTenQalys":595238.0952380951,"donorCostCeilingAt100kPerTenQalys":420,"status":"positive conditional gain"}},{"id":"pessimisticPositive","inputs":{"donorCashCostUsd":2000,"completeDirectResourceCostUsd":6000,"externalIntegratedQaly":0.006,"clinicalComparatorTransfer":0.5,"fundingAdditionality":0.25,"sharedIncrementalHarmQaly":0,"donorSpecificHarmQaly":0},"result":{"grossTransferredQaly":0.003,"netQalys":0.00075,"donorUsdPerTenQalys":26666666.666666668,"directResourceDiagnosticUsdPerTenQalys":80000000,"donorCostCeilingAt100kPerTenQalys":7.5,"status":"positive conditional gain"}}],"separateScenarios":[{"id":"nullFunding","reason":"Identical surgery already financed; donor spend remains","inputs":{"donorCashCostUsd":1000,"completeDirectResourceCostUsd":3500,"externalIntegratedQaly":0.056,"clinicalComparatorTransfer":0.5,"fundingAdditionality":0,"sharedIncrementalHarmQaly":0,"donorSpecificHarmQaly":0},"result":{"grossTransferredQaly":0.028,"netQalys":0,"donorUsdPerTenQalys":null,"directResourceDiagnosticUsdPerTenQalys":null,"donorCostCeilingAt100kPerTenQalys":0,"status":"no incremental health gain"}},{"id":"nullClinicalOrTiming","reason":"No actual net visual-health/time improvement","inputs":{"donorCashCostUsd":1000,"completeDirectResourceCostUsd":3500,"externalIntegratedQaly":0.056,"clinicalComparatorTransfer":0,"fundingAdditionality":0.5,"sharedIncrementalHarmQaly":0,"donorSpecificHarmQaly":0},"result":{"grossTransferredQaly":0,"netQalys":0,"donorUsdPerTenQalys":null,"directResourceDiagnosticUsdPerTenQalys":null,"donorCostCeilingAt100kPerTenQalys":0,"status":"no incremental health gain"}},{"id":"sharedLocalHarm","reason":"Extra local service harm of .04 QALY beyond harm already included in the trial; diagnostic magnitude, not an observed probability.","inputs":{"donorCashCostUsd":1000,"completeDirectResourceCostUsd":3500,"externalIntegratedQaly":0.056,"clinicalComparatorTransfer":0.5,"fundingAdditionality":0.5,"sharedIncrementalHarmQaly":0.04,"donorSpecificHarmQaly":0},"result":{"grossTransferredQaly":0.028,"netQalys":-0.006,"donorUsdPerTenQalys":null,"directResourceDiagnosticUsdPerTenQalys":null,"donorCostCeilingAt100kPerTenQalys":0,"status":"health-worsening stress"}},{"id":"donorDisruptionAtZeroAdditionality","reason":"Independent donor-driven disruption remains at zero extra beneficial surgery","inputs":{"donorCashCostUsd":1000,"completeDirectResourceCostUsd":3500,"externalIntegratedQaly":0.056,"clinicalComparatorTransfer":0.5,"fundingAdditionality":0,"sharedIncrementalHarmQaly":0,"donorSpecificHarmQaly":0.02},"result":{"grossTransferredQaly":0.028,"netQalys":-0.02,"donorUsdPerTenQalys":null,"directResourceDiagnosticUsdPerTenQalys":null,"donorCostCeilingAt100kPerTenQalys":0,"status":"health-worsening stress"}},{"id":"lowCashCapacitySensitivity","reason":"Unverified $250 subsidy with partners covering balance; not part of positive core or ranking","inputs":{"donorCashCostUsd":250,"completeDirectResourceCostUsd":2500,"externalIntegratedQaly":0.056,"clinicalComparatorTransfer":1,"fundingAdditionality":0.75,"sharedIncrementalHarmQaly":0,"donorSpecificHarmQaly":0},"result":{"grossTransferredQaly":0.056,"netQalys":0.042,"donorUsdPerTenQalys":59523.80952380952,"directResourceDiagnosticUsdPerTenQalys":595238.0952380951,"donorCostCeilingAt100kPerTenQalys":420,"status":"positive conditional gain"}},{"id":"secondEyeCounterweight","reason":"Separate randomized second-eye one-year estimate; not interchangeable with first-eye results.","inputs":{"donorCashCostUsd":1000,"completeDirectResourceCostUsd":3500,"externalIntegratedQaly":0.015,"clinicalComparatorTransfer":0.5,"fundingAdditionality":0.5,"sharedIncrementalHarmQaly":0,"donorSpecificHarmQaly":0},"result":{"grossTransferredQaly":0.0075,"netQalys":0.00375,"donorUsdPerTenQalys":2666666.666666667,"directResourceDiagnosticUsdPerTenQalys":9333333.333333334,"donorCostCeilingAt100kPerTenQalys":37.5,"status":"positive conditional gain"}},{"id":"otherwiseUntreatedLifetime","reason":"Separate Brown 13-year modeled first-eye lifetime-denial comparator; not the delay model or a ranking input.","inputs":{"donorCashCostUsd":1000,"completeDirectResourceCostUsd":3500,"externalIntegratedQaly":1.6212,"clinicalComparatorTransfer":0.5,"fundingAdditionality":0.5,"sharedIncrementalHarmQaly":0,"donorSpecificHarmQaly":0},"result":{"grossTransferredQaly":0.8106,"netQalys":0.4053,"donorUsdPerTenQalys":24673.081667900322,"directResourceDiagnosticUsdPerTenQalys":86355.78583765113,"donorCostCeilingAt100kPerTenQalys":4053,"status":"positive conditional gain"}}],"sources":[{"id":"pvfIdentityAndHub","url":"https://pacificvisionfoundation.org/pacific-vision-eye-institute/","title":"Pacific Vision Eye Institute","published":null,"type":"official provider","facts":"PVF EIN 94-2422439. The hub houses CPMC ophthalmology, Lions clinic and the surgery center.","limits":"Not the commercial Pacific Vision Institute. Shared care pathway, not independently additive partner outcomes.","retrieved":"2026-09-08"},{"id":"pvfPatients","url":"https://pacificvisionfoundation.org/for-patients/","title":"For Patients","published":null,"type":"official provider","facts":"Eligible free or reduced-cost patients are referred through Lions Eye Foundation Clinic, subject to physician referral and income/insurance requirements.","limits":"No priced marginal offer, donor restriction or available SF cohort established.","retrieved":"2026-09-08"},{"id":"pvf2025","url":"https://pacificvisionfoundation.org/wp-content/uploads/2026/07/FINAL-DIGITAL-PVF-Impact-Report-2025.pdf","title":"2025 Impact Report","published":"2025 report; URL uploaded 2026-07","type":"official provider report","locator":"Physical pages 7 and 16; patient stories elsewhere.","facts":"The Patient Assistance Fund covers surgery costs; 2,542 total surgeries and 570 total charity cases since 2020; shared regional CPMC/Lions pathway.","limits":"Not 570 annual cataracts or SF-only beneficiaries. A selected long-denial Nevada story does not establish the SF counterfactual. Patients' quoted prices elsewhere are not PVF costs.","retrieved":"2026-09-08"},{"id":"lionsEligibility","url":"https://www.lionseyefoundation.com/_files/ugd/fb7908_10991c70103941e7b3d2d4beba770914.pdf","title":"Patient Application and Eligibility Guidelines","published":"Effective 2026-01-01","type":"official program eligibility","facts":"Uninsured, including no government, county, private or partial coverage; one-year served-community residency, income verification and diagnostic physician referral.","limits":"Primary full PDF verified by the independent delivery auditor. Specific intake excludes insurance despite PVF's broader underinsured narrative; insured pathways remain unresolved.","retrieved":"2026-09-08"},{"id":"lionsServices","url":"https://www.lionseyefoundation.com/services-2","title":"Lions Eye Foundation services","published":"FY2024–25 financial display","type":"official partner","facts":"Partnerships with CPMC and PVF; all-procedure expenses and values are reported.","limits":"No mixed-budget/procedure division or general leverage multiplier enters cost. No cataract-specific marginal quote.","retrieved":"2026-09-08"},{"id":"firstEye","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC2095519/","alternateUrl":"https://eprints.soton.ac.uk/480801/","title":"Falls and health status in elderly women following first eye cataract surgery: an economic evaluation conducted alongside a randomised controlled trial","doi":"10.1136/bjo.2007.118687","published":"2007-12","type":"randomized trial economic analysis","facts":"306 women over 70 with bilateral cataracts; 75% had baseline acuity 6/12 or better. Expedited approximately four weeks versus a 12-month wait. There were 288 economic-analysis participants. One-year integrated QALY difference .056, 95% CI .006–.108.","limits":"Assignment-level integrated EQ-5D-derived QALYs, not a utility level or an annual benefit forever. The mild-impairment older female sample is not all local cases. Indexed primary and independent-auditor verification; this auditor's full PMC fetch was challenged.","retrieved":"2026-09-08"},{"id":"secondEye","url":"https://www.nature.com/articles/eye2009112","title":"Second-eye cataract surgery in elderly women: a cost-utility analysis conducted alongside a randomized controlled trial","doi":"10.1038/eye.2009.112","published":"2010-02; online 2009-05-15","type":"randomized trial economic analysis","facts":"239 women over 70 with previous first-eye surgery and minimal remaining-eye dysfunction; four-week versus 12-month wait. One-year QALY gain .015, 95% CI −.039–.068, p=.59.","limits":"Important null counterweight, not a first-eye effect. Historical £646 net payer cost is not delivery cost.","retrieved":"2026-09-08"},{"id":"brownLifetime","url":"https://www.sciencedirect.com/science/article/abs/pii/S0161642013005873","alternateUrl":"https://pubmed.ncbi.nlm.nih.gov/24246824/","title":"Cataract Surgery Cost Utility Revisited in 2012: A New Economic Paradigm","doi":"10.1016/j.ophtha.2013.04.030","published":"2013-12","type":"modeled patient-preference cost utility","facts":"PORT visual outcomes and time-tradeoff valuations; 1.6212 first-eye QALYs over 13 years; 2.8152 bilateral QALYs; historical 2012 direct ophthalmic cost $2,653.","limits":"Different method and long-term untreated comparator, not a randomized lifetime observation. No societal economic ROI or bilateral total is credited to one eye. Historical cost is not a current SF quote.","retrieved":"2026-09-08"}],"rationale":"The central estimate uses the randomized one-year delay benefit, halved for uncertain local/comparator fit and halved for funding replacement. The $1,000 cash amount is a bottom-up planning budget conditional on partner underwriting; neither that underwriting nor the marginal price is verified. This is a provisional best guess, not an evidence-weighted posterior or an available purchase. Favorable retains the trial mean rather than selecting the upper confidence limit; the low $250 cash case and long-denial model remain separate.","exclusions":["One shared cataract pathway counted once under PVF; no additive Lions, PVF or CPMC procedure-health claims.","No first-eye benefit for every second eye; no bilateral QALY total for one operation.","No automatic health tail beyond one year in the core; fixture or lens duration is not the duration of counterfactual benefit.","No extra fall-prevention, independence, mortality, productivity, caregiver or monetary ROI gains.","No treatment of donated partner inputs as costless resources; no historical all-procedure budget/volume unit cost.","No assumption that all regional patients are SF residents.","No use of a Nevada patient's outside quote as a PVF price or an SF delay distribution."],"acceptanceTests":["Reproduce all core and separate scenarios with finite-input checks.","Q <= 0 returns null for both prices but retains signed Q.","Zero funding and zero donor-specific harm gives zero even with shared harm; donor-specific harm at zero funding remains negative.","No additional QALY multiplier for one year or trial completion.","First-eye, second-eye and lifetime cases remain distinct; only the central core is used for ranking.","No verified funding-room or priced-offer claims; recipient, partners and SF-resident restriction remain visible."],"display":{"centralUsdPerTenQalys":714285.7142857143,"positiveCoreRange":[119047.61904761904,26666666.666666668],"rangeType":"Joint scenario judgments, not a confidence interval.","headline":"Earlier sight-restoring care, with an uncertain donor margin.","recommendationBoundary":"Real shared surgical pathway; hypothetical additional course and unknown funding room. Core favorable is above $100K per 10 QALYs; separate low-cash and long-denial sensitivities are not ranking inputs."},"evaluatedCore":[{"name":"central","grossTransferredQaly":0.028,"netQalys":0.014,"costPerTenQalys":714285.7142857143,"directResourcePrice":2500000,"donorCostCeilingAt100kPerTenQalys":140},{"name":"favorable","grossTransferredQaly":0.056,"netQalys":0.042,"costPerTenQalys":119047.61904761904,"directResourcePrice":595238.0952380951,"donorCostCeilingAt100kPerTenQalys":420},{"name":"pessimisticPositive","grossTransferredQaly":0.003,"netQalys":0.00075,"costPerTenQalys":26666666.666666668,"directResourcePrice":80000000,"donorCostCeilingAt100kPerTenQalys":7.5}],"evaluatedSeparate":[{"name":"nullFunding","grossTransferredQaly":0.028,"netQalys":0,"costPerTenQalys":null,"directResourcePrice":null,"donorCostCeilingAt100kPerTenQalys":0},{"name":"nullClinicalOrTiming","grossTransferredQaly":0,"netQalys":0,"costPerTenQalys":null,"directResourcePrice":null,"donorCostCeilingAt100kPerTenQalys":0},{"name":"sharedLocalHarm","grossTransferredQaly":0.028,"netQalys":-0.006,"costPerTenQalys":null,"directResourcePrice":null,"donorCostCeilingAt100kPerTenQalys":0},{"name":"donorDisruptionAtZeroAdditionality","grossTransferredQaly":0.028,"netQalys":-0.02,"costPerTenQalys":null,"directResourcePrice":null,"donorCostCeilingAt100kPerTenQalys":0},{"name":"lowCashCapacitySensitivity","grossTransferredQaly":0.056,"netQalys":0.042,"costPerTenQalys":59523.80952380952,"directResourcePrice":595238.0952380951,"donorCostCeilingAt100kPerTenQalys":420},{"name":"secondEyeCounterweight","grossTransferredQaly":0.0075,"netQalys":0.00375,"costPerTenQalys":2666666.666666667,"directResourcePrice":9333333.333333334,"donorCostCeilingAt100kPerTenQalys":37.5},{"name":"otherwiseUntreatedLifetime","grossTransferredQaly":0.8106,"netQalys":0.4053,"costPerTenQalys":24673.081667900322,"directResourcePrice":86355.78583765113,"donorCostCeilingAt100kPerTenQalys":4053}]}}