Summary
What do they do? HRTC provides mobile and low-threshold therapy. We model offering five alcohol-focused sessions over 12 weeks to adults experiencing homelessness with alcohol-use disorder, using external HaRT-A evidence. This is an analytic proposal within the adult mobile program, not a claim about the dose or protocol currently delivered. More
Why this approach interests us
- Low-threshold behavioral care can reach adults whom conventional abstinence-first services do not engage.
Our main reservations
- The evidence concerns a specific external alcohol intervention. The score-to-utility mapping has not been validated for change scores.
What do you get for your dollar?
Our exploratory best guess is $5.55M per better life (10 QALYs). This is a proposed alcohol-focused slice of Adult Mobile Behavioral Health, not a measured HRTC result or evidence that HRTC uses the exact trial protocol. We would not prioritize it on the current health-only estimate. Inspect the model and assumptions →
- our best guess
- $5.55M — per 10 incremental QALYs; subjective mapped-score model
- positive scenarios
- $493K–$444M — Not confidence bounds; null benefit remains possible
- cost per offer
- $1,500 — Modeled five-session course plus engagement time
- funding room
- Unverified — Existing public contracts are not donation capacity
1. What do they do?
HRTC provides mobile and low-threshold therapy. We model offering five alcohol-focused sessions over 12 weeks to adults experiencing homelessness with alcohol-use disorder, using external HaRT-A evidence. This is an analytic proposal within the adult mobile program, not a claim about the dose or protocol currently delivered.
Offer low-threshold care
Engagement and missed-appointment effort are included in the assumed course cost.
Deliver behavioral sessions
The selected external comparison is HaRT-A alone, excluding injection and medication arms.
Credit incremental health time
Allow usual care to catch up; do not turn persistent within-person improvement into a permanent treatment advantage.
Scope of this review. The city budget lists 4,530 staff hours at $198.64 and 500 planned clients for the adult mobile program. Budget targets are not executed costs, completed courses or causal outcomes; the separate transition-age-youth contract is excluded.
2. Monitoring and information sharing
Adults experiencing homelessness with alcohol-use disorder
Randomized behavioral-treatment comparison. HaRT-A alone improved physical SF-12 quality of life (d=0.41); no demonstrated mental-quality-of-life effect. Later active-group outcomes plateaued as usual care improved.
Our assessment. Unblinded treatment, missingness and protocol differences remain. Four physical points is a scenario, not d multiplied by a known trial standard deviation.
Adults experiencing homelessness with alcohol-use disorder
Earlier four-session randomized trial. Quality-of-life differences were inconclusive, despite improvement in alcohol outcomes.
Our assessment. Contrary evidence informs the transfer discount; alcohol outcomes are not added as separate QALYs.
SF-12/SF-36 population datasets
Group-average utility prediction. Hanmer supplies a preference-based SF-6D mapping coefficient for physical scores.
Our assessment. It does not establish the validity of mapping intervention-induced score changes.
3. Qualitative assessment
Low-threshold behavioral care can reach adults whom conventional abstinence-first services do not engage.
Key reservations
- Current HRTC course completion and preference-based utility outcomes are missing.
- The mapping and benefit-duration assumptions dominate a small modeled health gain.
- Even the optimistic positive scenario here exceeds $100K per 10 QALYs.
- This is not a model of medication, naloxone, overdose mortality or all HRTC services.
Benefits not included in our estimate
- 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
4. What do you get for your dollar?
Our best estimate: $5.55M per 10 QALYs.
Four physical-component points is an analyst scenario, not a recovered trial endpoint. Multiplying by 0.00781 gives a mapped peak utility change; we halve it for transfer and mapping uncertainty, integrate 18 full-effect-equivalent weeks, and halve again for funding additionality.
A better life is our comparison unit of 10 additional quality-adjusted life years (QALYs), potentially spread across people. These are uncertain estimates, not measured returns or verified donation offers.
How we calculate the estimate
DOLLARS PER BETTER LIFE: 10 × $1,500 ÷ (4 × 0.00781 × 50% × 18/52 × 50%)
≈ $5.55M per 10 QALYs
Model inputs and assumptions
- Donor cost per offered course
- 1500 (range: 1000 / 1500 / 2500). 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. Explicit analyst assumption.
- Peak incremental SF-12 physical score
- 4 (range: 6 / 4 / 1). 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. Explicit analyst assumption.
- Mapping and delivery transfer
- 0.5 (range: 1 / 0.5 / 0.25). 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. Explicit analyst assumption.
- Full-effect-equivalent weeks
- 18 (range: 30 / 18 / 6). 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. Explicit analyst assumption.
- Funding additionality
- 0.5 (range: 0.75 / 0.5 / 0.25). 50% allows replacement of existing public/private financing or alternative treatment. The existing contract is not available philanthropic capacity. Explicit analyst assumption.
Illustrative $100,000: 66.7 offered courses and 0.180 QALYs
- Optimistic positive: $493.19K per 10 QALYs. 2.028 QALYs per $100,000; conditional, not available funding room
- Central analyst estimate: $5.55M per 10 QALYs. 0.180 QALYs per $100,000; conditional, not available funding room
- Pessimistic positive: $443.88M per 10 QALYs. 0.002 QALYs per $100,000; conditional, not available funding room
Uncertainty. 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.
A health-score bridge, not measured QALYs
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.
SUBJECTIVE INCREMENTAL TRAJECTORY: 12-week linear rise / 2 + 24-week linear decline / 2
18 full-effect-equivalent weeks, not 36 weeks at peak
QALY conversion assumptions
The analysis is per course offered. Trial noncompletion is already embedded in treatment-assignment evidence; do not multiply by a completion rate again. The joint transfer factor allows different local delivery without pretending to measure it.
5. Funding and previous grants
An additional course, local health trajectory and incremental private-funding plan are not verified.
The adult mobile contract extends through June 2029 in the 2024 report. A new private gift may substitute for that funding. The budgeted all-in staff rate is only a cost anchor; current incremental staffing capacity must be established.
This review does not establish a verified marginal funding offer or a complete history of grants.
Opens the organization’s giving page. A general donation may not fund the specific activity modeled here; confirm allocation with the recipient.
6. Sources
- November 2024 contract report, printed page 5. SF Health Commission. Adult Mobile Behavioral Health budgeted hours and clients; not marginal course cost. Published: 2024-11-05; retrieved: 2026-09-07.
- Mission Mobile team and Gubbio. Harm Reduction Therapy Center. Local delivery description, not causal outcomes. Published: 2025-05; retrieved: 2026-09-07.
- Combining extended-release naltrexone and behavioral harm-reduction treatment: randomized clinical trial. Collins et al.. HaRT-A alone comparison only; physical quality of life, not measured QALYs. Published: 2021; retrieved: 2026-09-07.
- Randomized controlled trial of harm reduction treatment for alcohol. Collins et al.. Earlier four-session trial; inconclusive quality-of-life effect. Published: 2019; retrieved: 2026-09-07.
- Predicting an SF-6D Preference-Based Score Using MCS and PCS Scores from the SF-12 or SF-36. Hanmer, Value in Health. Group-average mapping; change-score validity not established. Published: 2009; retrieved: 2026-09-07.
Annual expenses: years and sources
Average annual expenses (three consecutive fiscal years): $2,742,777. Organization size is separate from the modeled cost-effectiveness of a donation.
Harm Reduction Therapy Center
Whole legal entity Form 990 Part IX total functional expenses; latest original reconstructed filings checked, fiscal-end year from printed reporting dates. Older fallback rows from IRS extracted API.
Latest original filings checked; ProPublica extracted API lags these original returns.