Summary
What do they do? The clinic serves uninsured people and lists vaccinations among its services. This review proposes additional shingles vaccination for eligible, otherwise unvaccinated adults; it does not claim the clinic currently participates in this manufacturer assistance pathway. More
Why this approach interests us
- Preventing shingles and persistent nerve pain can generate health gains; donated supply may reduce donor cash.
Our main reservations
- The favorable $92.6K result needs unusually low delivery costs, fast stock turnover and almost no substitution for existing vaccination.
What do you get for your dollar?
Our provisional central estimate is $1,954,995 per better life: 10 additional QALYs. We would investigate a tightly specified vaccine-access pilot, not recommend a general donation from this model. SFFC provides vaccinations, but its delivery of this specific product and assistance pathway is unverified. Inspect the model →
- our best guess
- $1,954,995 — per 10 QALYs; finite-cohort donor cash
- positive scenarios
- $92.6K–$121M — Joint judgments, not statistical bounds
- local delivery
- Product unverified — Generic vaccination service is confirmed
- funding room
- Unknown — No available tranche established
1. What do they do?
The clinic serves uninsured people and lists vaccinations among its services. This review proposes additional shingles vaccination for eligible, otherwise unvaccinated adults; it does not claim the clinic currently participates in this manufacturer assistance pathway.
Find genuinely additional patients
Verify clinical eligibility, prior vaccination, assistance eligibility and whether another provider would vaccinate them anyway.
Fund delivery and stock
Pay for applications, administration and purchased starting doses. Manufacturer replacement is vaccine inventory, not a cash refund. Ten approved doses must accumulate within12 months or replacement is forfeited. GSK does not pay for administration, and the provider cannot bill a public payer for it.
Complete the course
Track second doses, actual receipts and unused stock. Applications, referrals and leftover vaccine are not completed health gains.
Scope of this review. The age-70 cohort is hypothetical. Many people this age have Medicare and do not qualify for this assistance program. No evidence establishes sufficient eligible SFFC patients. This model cannot be used as personal vaccination advice or as the incremental effect of recalling dose two alone.
2. Monitoring and information sharing
Immunocompetent US adults vaccinated at ages 50, 60 or 70
Published lifetime economic model. Table 2 gives net discounted incremental QALYs of 0.001220, 0.003052 and 0.005392 respectively.
Our assessment. Imported modeled health, not an observed SFFC effect. Source completion and vaccine harms are already embedded; source societal cost offsets are not donor cash.
Uninsured clinic patients
Current clinic service disclosure. Vaccinations are listed; a product-specific service and assistance arrangement are not confirmed.
Our assessment. An educational sample note is not evidence of administered shingles doses.
Approved eligible patients at registered sites
Manufacturer assistance rules. In-kind ten-dose replenishment batches and an annual 200-dose site/product cap.
Our assessment. Stock must be purchased before use; other patients can consume the cap. Timing and remaining capacity require local verification.
3. Qualitative assessment
Preventing shingles and persistent nerve pain can generate health gains; donated supply may reduce donor cash.
Key reservations
- The health shortcut credits the published mixed-completion benefit only for completed courses, without dividing by 95.5%. Incomplete courses get no protection credit and an explicit adverse-burden allowance. This conservative convention is not an exact two-dose model or universal lower bound.
- Clinical transfer excludes completion; counterfactual share jointly represents alternate access, later vaccination and funding replacement. Do not multiply a second displacement discount.
- The old model assumes waning and lifetime survival rather than observing lifetime outcomes. New long-term follow-up exists; updating it requires disease-state modeling, not multiplying QALYs by a newer efficacy ratio. One source author disclosed manufacturer advisory work.
- The low-cost scenario depends on shared or donated labor and rapid replacement. Neither the patient count nor staff capacity is verified. Unpriced labor and costs can eliminate the apparent advantage.
- Stock balance does not prove each injection can occur on time. Count only receipts, not expected approvals, and model extra purchases if shipments arrive late.
Benefits not included in our estimate
- Protection from incomplete courses
- Future use of terminal stock
- Healthcare and productivity cost savings
- Other vaccines or other clinic services
4. What do you get for your dollar?
$1,954,995 per 10 QALYs
The central pilot assumes 20 starts and 16 completed courses. It purchases 20 starting doses, administers 36 and receives 30 replacement doses. Gross cash is $5,933.80; 14 doses remain as stock with no cash or future-health credit. Our completed-course health proxy yields 0.03035 additional lifetime QALY for the cohort.
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 × gross donor cash ÷ [(completed × source Q × clinical transfer − incomplete-course harm) × counterfactual share − extra harm]
$1,954,995 per 10 QALYs
Model inputs and assumptions
- First-dose starts
- 20 (range: 100 / 20 / 4). See source audit and scenario limitations below. Analyst judgment, not local measurement.
- Completed courses
- 16 (range: 95 / 16 / 2). See source audit and scenario limitations below. Analyst judgment, not local measurement.
- Benchmark age
- 70 (range: 70 / 70 / 60). See source audit and scenario limitations below. Analyst judgment, not local measurement.
- Clinical transfer, excluding completion
- 0.75 (range: 0.9 / 0.75 / 0.5). See source audit and scenario limitations below. Analyst judgment, not local measurement.
- Gift-attributable benefit share
- 0.5 (range: 0.9 / 0.5 / 0.25). See source audit and scenario limitations below. Analyst judgment, not local measurement.
- QALY harm allowance per incomplete course
- 0.001 (range: 0.0005 / 0.001 / 0.001). See source audit and scenario limitations below. Analyst judgment, not local measurement.
- Purchased starting inventory
- 20 (range: 10 / 20 / 10). See source audit and scenario limitations below. Analyst judgment, not local measurement.
- Paid administration per dose
- 15 (range: 5 / 15 / 30). See source audit and scenario limitations below. Analyst judgment, not local measurement.
- Paid navigation per starter
- 20 (range: 5 / 20 / 40). See source audit and scenario limitations below. Analyst judgment, not local measurement.
- Setup cash
- 300 (range: 0 / 300 / 500). See source audit and scenario limitations below. Analyst judgment, not local measurement.
- Dose acquisition price proxy
- 234.69 (range: 234.69 / 234.69 / 234.69). See source audit and scenario limitations below. Manufacturer list-price proxy; not clinic quote.
- Additional unitemized cash allowance
- 0 (range: 0 / 0 / 0). Zero is an explicit unquantified omission, not evidence these resources are free. See cost boundaries. Analyst judgment, not local measurement.
- Additional donated-labor valuation
- 0 (range: 0 / 0 / 0). Zero is an explicit unquantified omission, not evidence these resources are free. See cost boundaries. Analyst judgment, not local measurement.
A hypothetical $5,934 pilot—not a verified funding request
- Favorable: $92,615 per 10 QALYs. $3,822 cash; 0.4127 cohort QALYs; 5 terminal doses.
- Central: $1,954,995 per 10 QALYs. $5,934 cash; 0.03035 cohort QALYs; 14 terminal doses.
- Unfavorable: $121,174,905 per 10 QALYs. $3,187 cash; 0.0002630 cohort QALYs; 4 terminal doses.
Uncertainty. No incremental vaccination means no positive estimate. Negative net QALYs are possible in the model; an incomplete-only case omits partial protection and does not demonstrate that one-dose vaccination is biologically harmful.
A narrow favorable case—not a robust sub-$100K finding
The favorable case starts 100 eligible age-70 patients, completes 95 courses and uses a ten-dose stock buffer. Its cash headroom below the target is only about $305. Two more purchased buffer doses would exceed the threshold. The central cohort would need total cash below $304, compared with nearly $6,000 modeled.
TARGET CASH CEILING: $100,000 ÷ 10 × cohort incremental QALYs
$304 at central health
QALY conversion assumptions
- Favorable plus two buffer doses: $103,990 per 10 QALYs. No extra patient benefit is credited for unused inventory.
- Central consumed-resource price proxy: $3,192,159 per 10 QALYs. Values consumed vaccine at list price and delivery cash; donated labor remains unpriced. Not the ranking numerator.
- Complete funding substitution: No positive benefit. Cash is still spent if the gift merely replaces existing vaccination support.
Reusing already-financed stock could make a later marginal cohort cheaper, but capital and health boundaries must extend together. Do not count the same manufacturer-leveraged health again as an additional benefit.
5. Funding and previous grants
No verified SFFC shingles expansion, eligible patient cohort, itemized quote or marginal funding offer.
Gross donor cash includes initial inventory without salvage. Shipment cadence is assumed adequate; the year-end stock equation is not a dated delivery simulation. Additional cold-chain, screening failures, finance, supervision and donated staff costs are not fully itemized. A separate consumed-resource proxy values all used vaccine at list price but omits unpriced labor and is not 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
- Primary care for uninsured people. San Francisco Free Clinic. Organization service description. Published: Undated; retrieved: 2026-09-07.
- Published lifetime zoster vaccination economic model: Tables 1–2. Open Forum Infectious Diseases. Primary economic model. Published: 2019; retrieved: 2026-09-07.
- Vaccine eligibility and application. GSK Patient Access Programs Foundation. Program terms. Published: Undated current page; retrieved: 2026-09-07.
- Replenishment application, page 1. GSK Patient Access Programs Foundation. Primary program rules. Published: 2024-04; retrieved: 2026-09-07.
- SHINGRIX English list price. GSK. Manufacturer list-price anchor. Published: 2026-01-01 price; retrieved: 2026-09-07.
- Final ZOE-LTFU analysis to 11 years. EClinicalMedicine. Primary long-term extension study. Published: 2025-05-09; retrieved: 2026-09-07.
Annual expenses: years and sources
Average annual expenses (three consecutive fiscal years): $2,745,998. Organization size is separate from the modeled cost-effectiveness of a donation.
San Francisco Free Clinic
Form 990 reported whole-entity expenses; includes program, administration and fundraising costs, but excludes costs netted against revenue.
Calendar years ended December 31. Latest listed original return is 2024; current-year total expenses verified in each original return.