Summary
What do they do? HealthRIGHT 360’s Integrated Care Center at 1563 Mission lists medication-assisted treatment alongside primary, dental and mental-health care. This review considers additional nurse-led outpatient access, not residential treatment, the whole organization or a confirmed proposed project. More
Why this approach interests us
- More medication-covered time can reduce mortality and improve health for people otherwise unable to obtain effective treatment.
Our main reservations
- Added staffing is expensive and much observed care would happen anyway. Our local effect, mortality transfer and funding assumptions are highly uncertain.
What do you get for your dollar?
Our best guess is $26,353,957 per better life: 10 incremental QALYs for a hypothetical two-year nurse-led access expansion. We would not prioritize this full-capacity package for a donor seeking under $100,000 per better life. A much cheaper, genuinely binding access bottleneck could change our view, but cannot inherit the whole clinical team’s effect. Inspect the model →
- our best guess
- $26,353,957 — per 10 QALYs; hypothetical two-year capacity package
- positive scenarios
- $261K–$10.3B — Joint analyst cases, not confidence bounds; null/harm possible
- evidence
- Very low for price — External access trial; observational mortality; local transfer judgment
- funding room
- Unverified — Existing services are not a marginal funding offer
1. What do they do?
HealthRIGHT 360’s Integrated Care Center at 1563 Mission lists medication-assisted treatment alongside primary, dental and mental-health care. This review considers additional nurse-led outpatient access, not residential treatment, the whole organization or a confirmed proposed project.
Find a binding capacity gap
Establish whether nursing, prescribing, appointments or another obstacle prevents treatment that would not be obtained elsewhere.
Measure additional covered time
Count medication-covered person-years beyond usual care. Offers, appointments and starts are intermediate steps, not independent benefits.
Translate to health
Apply an explicitly uncertain mortality bridge and a small subjective nonfatal utility gain; reconcile public funding and shared patients.
Scope of this review. Program availability does not establish same-day prescribing, an open slot or an unfunded expansion. A nonclinical navigator is a different intervention and cannot simply borrow a nurse-team trial effect.
2. Monitoring and information sharing
Twelve primary-care clinics in six US systems; two years after randomization
PROUD cluster randomized trial. Adjusted gain: 8.2 medication-years per 10,000 patients; the measured treatment included buprenorphine and extended-release naltrexone.
Our assessment. Six intervention clinics establish our reference size, not ICC reach. A further expansion may have a smaller effect than introducing the model.
Newly treated and ongoing medication patients over three years
Secondary trial analysis. No measurable increase in treatment duration among treated patients; benefits primarily reflected access.
Our assessment. Do not apply an additional retention multiplier. The absence of a significant effect is not proof that every retention intervention fails.
Older buprenorphine cohorts, not contemporary San Francisco
Meta-analysis of observational cohorts. Pooled mortality was 4.3 versus 9.5 deaths per 1,000 person-years in versus out of treatment.
Our assessment. Unadjusted associations are not causal risk differences. We retain half the difference by judgment; cessation risk and population selection remain unresolved.
PROUD implementation; national 2023 prices and an assumed 75 monthly treated-patient caseload
Primary microcosting. Clinical package: $238,888 first year and $229,676 subsequent year.
Our assessment. Neither a local quote nor a cost per additional treated person. Pharmacy resources are separately stress-tested rather than claimed to be included in the clinical totals.
3. Qualitative assessment
More medication-covered time can reduce mortality and improve health for people otherwise unable to obtain effective treatment.
Key reservations
- Do not add these benefits to HYA access or SFAF/DOPE rescue benefits for the same person-time and avoided deaths. This rare-event approximation is for one two-year tranche; repeated tranches need a person-level survival model, not fresh independent lifetime credit every year.
- The 0.03 nonfatal utility gain is an analyst judgment, not a measured treatment effect. Both it and mortality transfer can be zero or negative.
- The model gives no mortality or utility credit to naltrexone time; it does not claim naltrexone lacks benefit or advise patients to switch medications.
- City outpatient budgets include other behavioral services and cannot be divided by clients to obtain marginal medication cost. Existing payer support can displace a gift.
- Five future discounted QALYs per avoided acute death is a survival assumption, not permanent protection from treatment. Repeated grants require deduplicated person-time and survival accounting.
Benefits not included in our estimate
- Nonfatal benefits outside the explicitly modeled 0.03 utility increment
- Family welfare, income and criminal-legal outcomes
- Effects of naltrexone and other medications
- Healthcare cost offsets and patient time
4. What do you get for your dollar?
Our best estimate: $26,353,957 per 10 QALYs
We calibrate one clinic to 171,526 patients across six trial intervention clinics and 8.2 additional medication-years per 10,000 patients over two years: 23.44 medication-years. Halving the transferred access effect, then applying 50% funding additionality and 90% buprenorphine share leaves 5.27 additional buprenorphine-years. Clinical costs of $238,888 plus $229,676 are multiplied by a judgmental 1.25 local/current-cost factor: $585,705. Costs are undiscounted; benefits are placed at year one and discounted 3%. The trial’s rollout window and the costing study’s first-treatment-year clock are not identical.
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 × donor cost ÷ [added buprenorphine-years × ((0.0095 − 0.0043) × 0.5 × 5.154 + 0.03) ÷ 1.03]
$26,353,957 per 10 QALYs
Model inputs and assumptions
- Local/current capacity-cost factor
- 1.25 (range: 0.8 / 1.25 / 1.6). 1.25 is a judgmental uplift to 2023 national clinical resource costs, not a measured SF quote or inflation series. Source calibration or explicit judgment; see basis.
- Two-year primary-care population
- 28587.666666666668 (range: 28587.666666666668 / 28587.666666666668 / 28587.666666666668). 171526 / 6 intervention clinics is a trial-scale reference, not ICC's patient count. The 75 monthly treated-patient costing assumption is a different denominator. Source calibration or explicit judgment; see basis.
- Added medication-years per 10,000 over TWO years
- 8.2 (range: 16.4 / 8.2 / 5.4). Central 8.2 from PROUD adjusted trial result; optimistic 16.4 is a speculative doubling, pessimistic 5.4 is its one-sided lower bound. Cases are not confidence intervals. Source calibration or explicit judgment; see basis.
- Transfer of trial access effect
- 0.5 (range: 1 / 0.5 / 0.2). Further expansion at an existing integrated clinic may do less than introducing a nurse model. This includes alternative treatment displaced; do not discount access twice. Source calibration or explicit judgment; see basis.
- Funding additionality
- 0.5 (range: 1 / 0.5 / 0.25). Probability-equivalent share of the added capacity not supplied by existing public/private funding. Separate from patient-level access transfer. Source calibration or explicit judgment; see basis.
- Buprenorphine share of extra medication time
- 0.9 (range: 1 / 0.9 / 0.7). Judgment: no current ICC drug mix observed. Remaining naltrexone time receives no mortality credit, not a claim of no benefit. Source calibration or explicit judgment; see basis.
- Out-of-treatment mortality per person-year
- 0.0095 (range: 0.05 / 0.0095 / 0.008). Central 0.0095 is an older pooled cohort calibration; not measured contemporary SF risk. Higher-risk optimistic case is a judgment. Source calibration or explicit judgment; see basis.
- In-treatment mortality per person-year
- 0.0043 (range: 0.015 / 0.0043 / 0.006). Central 0.0043 from the same cohort synthesis; selection/confounding prevent causal interpretation. Source calibration or explicit judgment; see basis.
- Causal/transport retention of mortality difference
- 0.5 (range: 0.8 / 0.5 / 0.25). Central 50% is an explicit judgment, not an estimated confidence adjustment. No additional overdose-specific benefit is added to all-cause survival. Source calibration or explicit judgment; see basis.
- Survivor health utility
- 0.7 (range: 0.8 / 0.7 / 0.6). Judgmental shared mortality-model value, not a treatment-induced utility gain. Source calibration or explicit judgment; see basis.
- Post-prevented-death annual hazard
- 0.08 (range: 0.055 / 0.08 / 0.15). Judgmental conditional survival trajectory after the avoided acute death, not lifetime treatment efficacy. Source calibration or explicit judgment; see basis.
- Post-event survival horizon
- 15 (range: 20 / 15 / 10). 15 years central; future survival discounted at 3% annually. No indefinite medication protection assumed. Source calibration or explicit judgment; see basis.
- Additional nonfatal utility while covered
- 0.03 (range: 0.1 / 0.03 / 0). Analyst best guess 0.03, not a measured local gain or a published utility level. Optimistic 0.10 and pessimistic zero; apply only during added buprenorphine time, not indefinitely. Source calibration or explicit judgment; see basis.
Illustrative $100,000: 0.0379 QALYs, not available funding room
- Optimistic positive: $260,540 per 10 QALYs. 46.9 additional buprenorphine-years; 14.4 QALYs per two-year package.
- Central analyst estimate: $26,353,957 per 10 QALYs. 5.27 additional buprenorphine-years; 0.222 QALYs per two-year package.
- Pessimistic positive: $10,257,003,928 per 10 QALYs. 0.54 additional buprenorphine-years; 0.000731 QALYs per two-year package.
Uncertainty. Zero additional coverage or full funding substitution gives zero benefit absent extra harm. With coverage, zero mortality benefit and zero nonfatal utility gain together produce zero health benefit. Greater in-treatment mortality or extra cessation-related deaths can produce harm. The pooled out-of-treatment rate already includes cessation periods; extra deaths are a stress test beyond that calibration, not an estimated additive penalty.
What would reverse our conclusion?
At the central health effect, donor cash would have to fall below $2,222 for the entire package to beat $100,000 per 10 QALYs. That is a threshold, not an available offer. Even our favorable full-team scenario remains above the target. A lower-cost supplemental proposal needs its own additionality evidence, not attribution of benefits already purchased by public care.
MAXIMUM CASH AT THIS HEALTH EFFECT: Central net QALYs × $10,000 per QALY
$2,222
QALY conversion assumptions
- Mortality only; no subjective nonfatal utility gain: $85,352,928 per 10 QALYs. Tests the health-utility judgment instead of presenting a published health-state level as a causal gain.
- Zero additional access and zero extra harm: No finite positive price. Existing patients served differently without extra medication coverage produce no modeled benefit.
- 0.05 extra deaths beyond the calibration: No finite positive price. Illustrative cessation/implementation harm stress test, not an estimated local penalty.
Do not add these benefits to HYA access or SFAF/DOPE rescue benefits for the same person-time and avoided deaths. This rare-event approximation is for one two-year tranche; repeated tranches need a person-level survival model, not fresh independent lifetime credit every year.
5. Funding and previous grants
No priced, unfunded ICC expansion or current incremental treatment-time outcome has been verified.
Donor cash for a full clinical capacity package. Incremental pharmacy costs are separately displayed as resources; central donor pharmacy share is zero only under an explicit public-payment assumption, not verified reimbursement. No cost offsets deducted. The full-resource version is $26,881,344 per 10 QALYs, adding $1,000 per local incremental medication-year as an unverified pharmacy-cost assumption. It still excludes later healthcare and patient time; it is not a complete societal CEA.
This review does not establish a verified marginal funding offer or a complete history of grants.
We have not verified a suitable donation route for this reviewed activity. Confirm the legal recipient and intended allocation before donating.
6. Sources
- Integrated Care Center. HealthRIGHT 360. Local provider disclosure. Published: Undated; current service page; retrieved: 2026-09-07.
- PROUD cluster randomized clinical trial. JAMA Internal Medicine. Primary cluster randomized trial. Published: 2023; retrieved: 2026-09-07.
- PROUD treatment-duration secondary analysis. Drug and Alcohol Dependence. Primary trial secondary analysis. Published: 2024; retrieved: 2026-09-07.
- Cost of implementing and sustaining the Massachusetts model. American Journal of Managed Care. Primary microcosting study; 2023 USD. Published: 2026-04-22; retrieved: 2026-09-07.
- Mortality during and after opioid substitution treatment. BMJ. Original meta-analysis of observational cohorts. Published: 2017-04-26; retrieved: 2026-09-07.
Annual expenses: years and sources
Average annual expenses (three consecutive fiscal years): $172,367,324. Organization size is separate from the modeled cost-effectiveness of a donation.
HealthRIGHT 360
IRS Form 990 whole-entity total expenses, Part I line 18; fiscal years ending June 30
Operating entity across its full geography, not the separate HealthRIGHT 360 Foundation and not SF-only expenses. FY2023 from prior-year column of FY2024 return.