Summary
What do they do? A March 2025 collaborative schedule places Street Medicine and buprenorphine services at HYA. The modeled philanthropic role is additional engagement and retention support, conditional on clinical and pharmacy capacity. It is not a claim that HYA alone provides or finances the medication. More
Why this approach interests us
- Low-threshold support can help someone begin and remain on treatment that is associated with lower mortality.
Our main reservations
- Local additional uptake, coverage days and marginal staffing cost are unmeasured; the mortality association comes from a different adult cohort.
What do you get for your dollar?
Our conditional best guess is $4.69M per better life (10 QALYs). This models HYA-supported initiation and retention through a collaborative clinic, not all HYA work. It counts additional medication-covered time, not referrals as successful treatment. We would seek a specific expansion plan before prioritizing a gift. Inspect the inputs and calculations →
- our best guess
- $4.69M — per 10 incremental QALYs; conditional mortality-only scenario
- positive scenarios
- $77K–$1.48B — Not confidence bounds; optimistic case is not the expected price
- cost per initiation
- $2,793 — Assumed ten support hours at a shared-service benchmark
- funding room
- Unverified — Public medication and clinical capacity are complementary
1. What do they do?
A March 2025 collaborative schedule places Street Medicine and buprenorphine services at HYA. The modeled philanthropic role is additional engagement and retention support, conditional on clinical and pharmacy capacity. It is not a claim that HYA alone provides or finances the medication.
Support actual initiation
Allocate engagement effort across supported starts; referral counts alone do not demonstrate medication access.
Add covered time
Follow fills and coverage days. Sporadic prescriptions, appointments and adherence are distinct measures.
Estimate survival benefit cautiously
Apply an externally observed mortality association only to additional time, with explicit causal and population uncertainty.
Scope of this review. HYA, GLIDE and HRTC are named subcontractors in the May 2026 proposed SFAF agreement. Prime-only ledgers miss subcontract exposure. This is distinct from the historical $250K/26,016-dose anchor, with no verified supersession crosswalk. Do not add this mortality estimate to full SFAF naloxone benefits for overlapping people.
2. Monitoring and information sharing
95 homeless heroin injectors; mean age 39.2
Uncontrolled SF Street Medicine cohort. Medication retention was 37%, 27%, 27%, 26% and 18% at months 1, 3, 6, 9 and 12.
Our assessment. Active prescriptions for over two weeks in a sampled month were the criterion—not adherence. Three covered months is a judgment, not calculated from these observations or specific to HYA youth.
Massachusetts adult overdose survivors
Adjusted observational cohort. Buprenorphine was associated with lower all-cause mortality: adjusted hazard ratio 0.63, with 95% interval 0.46–0.87.
Our assessment. Residual confounding and local risk differences remain; the model discounts the association and does not interpret it as an HYA causal effect.
SFAF and named subcontractors
Proposed city agreement. A shared $279.32 service-hour benchmark spans many activities and organizations.
Our assessment. Not an HYA marginal rate or a buprenorphine course cost. Ten hours is an analyst allocation.
3. Qualitative assessment
Low-threshold support can help someone begin and remain on treatment that is associated with lower mortality.
Key reservations
- The next gift may replace existing support rather than add medication-covered time.
- The external adult risk and survival assumptions may poorly describe HYA recipients.
- Publicly funded clinical services must have spare capacity for support spending to translate into treatment.
- Do not add full modeled HYA and SFAF mortality benefits for overlapping recipients or shared funding.
Benefits not included in our estimate
- Naloxone rescues
- Nonfatal morbidity and quality-of-life gains during treatment
- Housing, employment and family benefits
- Publicly financed medication and prescriber costs
- Healthcare savings
4. What do you get for your dollar?
Our best estimate: $4.69M per 10 QALYs.
The central scenario assumes $2,793.20 per supported start, half genuinely additional, three medication-covered months, a 5% annual untreated mortality rate, an associated hazard ratio of 0.63, half-strength causal/population transfer and about 5.1541 QALYs per averted death.
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 × $2,793.20 ÷ [50% × 0.25 × 0.05 × (1 − 0.63) × 50% × 5.1541]
≈ $4.69M per 10 QALYs
Model inputs and assumptions
- Donor cost per supported initiation
- 2793.2 (range: 1000 / 2793.2 / 6000). Ten assumed service hours * $279.32 shared-service budget benchmark = $2,793.20. The broad SFAF bundle is not an HYA-specific marginal rate. Includes failed engagement effort allocated over initiations; not ten hours of prescriber time. External anchor or explicit analyst assumption.
- Additional uptake and funding
- 0.5 (range: 0.75 / 0.5 / 0.25). 50% jointly allows alternative treatment access and replacement of existing finance. Conditional on prescriber and pharmacy capacity. External anchor or explicit analyst assumption.
- Medication-covered years per initiation
- 0.25 (range: 0.5 / 0.25 / 0.08333333333333333). Three months is a judgment informed loosely by intermittent SF retention, not an area calculated from sparse observations. Active prescriptions do not prove adherence. No extra completion multiplier is applied. External anchor or explicit analyst assumption.
- Untreated annual mortality rate
- 0.05 (range: 0.08 / 0.05 / 0.02). 5% is transferred from an older Massachusetts adult overdose-survivor cohort; youth baseline risk may differ substantially. External anchor or explicit analyst assumption.
- External mortality association
- 0.63 (range: 0.46 / 0.63 / 0.87). 0.63 is adjusted observational association, not randomized causal effect. The source's primary exposure includes the month after discontinuation; using it for covered time is an approximation. External anchor or explicit analyst assumption.
- Causal and population transfer
- 0.5 (range: 1 / 0.5 / 0.25). 50% jointly discounts residual confounding and transfer to HYA-supported recipients. It is not a measured correction. External anchor or explicit analyst assumption.
- Healthy survival per averted death
- 5.1541 (range: 8 / 5.1541 / 3). 5.1541 reuses the SFAF illustration: utility 0.70, annual hazard 0.08, 15-year horizon and 3% discount. Consistency does not validate transfer to youth; this is not a joint longitudinal medication/survival model. External anchor or explicit analyst assumption.
Illustrative $100,000: 35.8 supported starts and 0.213 QALYs
- Optimistic positive: $77.16K per 10 QALYs. 12.960 QALYs per $100,000; not a funding offer
- Central analyst estimate: $4.69M per 10 QALYs. 0.213 QALYs per $100,000; not a funding offer
- Pessimistic positive: $1.48B per 10 QALYs. 0.001 QALYs per $100,000; not a funding offer
Uncertainty. No additional medication-covered time or no transferred mortality benefit means no finite price. Positive scenarios are not confidence intervals. Discontinuation risk, adverse effects and repeated recipients require a fuller signed longitudinal model.
The under-$100K result requires several favorable assumptions together
The optimistic case combines cheaper support, greater additionality, six covered months, a higher-risk population, a stronger association and more future healthy survival. It is a stress scenario, not independent evidence of a cheap marginal HYA opportunity.
CENTRAL QALYS PER SUPPORTED START: 0.5 × 0.25 × 0.05 × 0.37 × 0.5 × 5.1541
0.005959 QALYs
QALY conversion assumptions
Rate multiplied by duration is a small-risk approximation. The external primary exposure includes a post-discontinuation month; transferring it to medication-covered time is approximate. The constant future-survival illustration does not model treatment transitions, aging or repeated interventions.
5. Funding and previous grants
No verified additional HYA allocation, prescriber capacity or linked medication-covered-time outcome is available.
The May 2026 shared grant is proposed, subject to final city budgets; neither payment nor a specific subcontract amount is established here. The model excludes publicly financed medication and prescriber costs, so it is a donor-budget model rather than a societal ICER.
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
- March 2025 service schedule. SF collaborative syringe-access services. HYA-site Street Medicine and buprenorphine service identity, not initiation outcomes. Published: 2025-03; retrieved: 2026-09-07.
- Proposed SFAF agreement 1000037481. SF Health Commission. Shared proposed service-cost benchmark and named subcontractors; not paid grants. Published: 2026-05-04; retrieved: 2026-09-07.
- Low barrier buprenorphine treatment for persons experiencing homelessness and injecting heroin in San Francisco. Carter, Zevin and Lum. Uncontrolled 95-person SF cohort; medication retention differs from adherence. Published: 2019-05-06; retrieved: 2026-09-07.
- Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality. Larochelle et al., Annals of Internal Medicine. Observational mortality association; excludes deaths in first 30 days after index overdose. Published: 2018-06-19; retrieved: 2026-09-07.
- Versioned survival illustration and original cohort/utility sources. Market for Impact. Internal analyst assumption provenance, not independent evidence. Published: 2026-09-07; retrieved: 2026-09-07.
Annual expenses: years and sources
Average annual expenses (three consecutive fiscal years): Not available. Organization size is separate from the modeled cost-effectiveness of a donation.
Homeless Youth Alliance Inc
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.
- FY2025: $1,563,662
- FY2024: $1,328,125
- FY2023: $636,650 (partial fiscal year; excluded from the three-year mean)
Three consecutive full-year expense totals are not verified.
Latest original filings checked; ProPublica extracted API lags these original returns. CAUTION: FY2023 covers Jan 1–June 30 only (six-month transition period). Do not present a simple mean as three full annual expenses; leave annual average unavailable or explicitly disclose partial-year coverage.