Cribs for Kids

Ordinary unrestricted recipient donation, not a restricted local crib purchase. G=$10,000 is calculation normalization. a allocates the donation to the material-plus-education pathway; c includes its procurement, delivery, teaching, follow-up and proportional support costs. All other dollars remain in the donor numerator. Commercial partner purchases are not treated as donation-caused. No offset from retail sales or medical savings is claimed. Other program health effects are unquantified rather than assumed scientifically zero.

Local grants and the core partner network serve US communities. Central g=.99 and pessimistic.95 allow overseas military, Canadian/Israeli hospital and other foreign spillovers, which the return explicitly mentions. g is a judgment about outcome-weighted resident benefit, not the fraction of hospitals. USA means50states+DC, not citizenship.

N = (G×a/c)×b. Δdeaths = N×u×r×e. Q_all = Δdeaths×L. Q_USA = Q_all×g. Price per10 =10G/Q_USA. u is the incremental full-risk-period-equivalent transition to safer sleep, already discounting alternative crib access, partial use and delayed provision; r is the remaining sleep-related mortality risk of infants whose behavior changes, and e is the causal fraction removed by that change. L is discounted QALYs per prevented infant death. No separate education effect is added to the same infant.

G

10000 USD normalization (judgment). Arithmetic only; not a confirmed funding tranche.

FY2025 functional expense

2633922 USD (observed). Form990 PartIX, excludes COGS and direct event costs. [cfk-99025]

FY2025 COGS

9231646 USD (observed). PartVIII line10b; must restore for gross costs. [cfk-99025]

FY2025 direct event costs

49675 USD (observed). PartVIII line8b, separate from functional fundraising expense. [cfk-99025]

FY2025 gross accounting expense

11915243 USD (observed). 2633922+9231646+49675; not annual cash outflow or marginal cost. [cfk-99025]

a

0.5 material-pathway allocation (judgment). Material-resource functional expense1277796 is48.5% of2633922, but commercial mix prevents a direct allocation inference. Use.5 prior, range.2–.8; other pathways' health remains unquantified. [cfk-99025] [cfk-faq]

c

500 USD/supported material package (judgment). No current quote. Broad full-support allowance for crib/accessories, freight, teaching and support, range175–1000. Does not use net operating expense/partner shipments. A current unit-cost and allocation budget is decisive. [cfk-catalog] [cfk-building] [cfk-99025]

b

0.5 funding/capacity additionality (judgment). Sales profits, inventories/reserves and grant commitments could finance the same work; range.2–.9 and zero. [cfk-99025] [cfk-faq]

u

0.2 incremental risk-period-equivalent safer-sleep share (judgment). Well below observed crib use; multisite study finds most would otherwise use recommended surfaces, selective follow-up and practice decline. Includes replacement access, inconsistent use and late delivery; range.05–.6. [cfk-multisite] [cfk-homevisit] [cfk-qual26] [sleep-mobile-rct]

r

0.002 remaining sleep-related death risk/behavior-changing infant (judgment). Two per1000 for targeted unsafe-sleep subgroup, not national mean. National SUID burden about3400 deaths in2024 supplies scale, not this subgroup rate. Range.001–.004. [sleep-cdc] [sleep-risk-pooled] [sleep-risk-context]

e

0.5 causal risk fraction removed (judgment). Conservative relative reduction for genuinely changed hazardous sleep conditions; cannot prevent every SUID mechanism. Range.2–.7, plus zero; no case-control odds ratio directly treated as intervention efficacy. [sleep-aap] [sleep-risk-pooled] [sleep-risk-context]

L

27 discounted QALYs/prevented infant death (judgment). Approximate80-year horizon at.9 average utility and3% discount gives27.2 before further competing-risk allowance; round27. Range22–30. No parental bereavement or lifetime economic output added.

g

0.99 USA resident health share (judgment). Core domestic distribution, with explicit foreign/military hospital reach. Outcome-weighted share unknown; range.95–1. [cfk-99025]

Hospital/system pathway incremental health

null QALYs/USD (unknown). Need newly improved births attributable to national funding, durable practice change and appropriate risk bridge. Births reached and ecological mortality decline cannot identify it. [cfk-99025] [sleep-hospital25] [sleep-prams25]

Cautious material-provision pathway: Cost: $10K; USA QALYs: 0.02673; all-population QALYs: 0.027. a=0.5; c=500; b=0.5; u=0.2; r=0.002; e=0.5; L=27; g=0.99; additional packages=5; prevented deaths=0.001. Judgment-only material pathway; other health mechanisms unquantified.

Low-cost provision reaching otherwise unsafe high-risk sleep: Cost: $10K; USA QALYs: 2.0736; all-population QALYs: 2.0736. a=0.8; c=175; b=0.9; u=0.6; r=0.004; e=0.7; L=30; g=1; additional packages=41.142857142857146; prevented deaths=0.06912. Judgment-only material pathway; other health mechanisms unquantified.

Limited allocation, behavior change and preventable risk: Cost: $10K; USA QALYs: 0.00008360000000000003; all-population QALYs: 0.00008800000000000004. a=0.2; c=1000; b=0.2; u=0.05; r=0.001; e=0.2; L=22; g=0.95; additional packages=0.4; prevented deaths=0.0000040000000000000015. Judgment-only material pathway; other health mechanisms unquantified.

Existing resources or alternative equipment fully substitute: Cost: $10K; USA QALYs: 0; all-population QALYs: 0. b=0 or u=0; no additional safe sleep or mortality benefit.

Behavior changes mainly among low-hazard families: Cost: $10K; USA QALYs: 0.0040095; all-population QALYs: 0.00405. Central inputs but r×e=.00015 instead of.001, resembling a low absolute risk difference from external case-control modeling. Not a directly transferable effect.

Central with undiscounted lifetime benefit: Cost: $10K; USA QALYs: 0.07425; all-population QALYs: 0.075. L=75 undiscounted QALYs; central otherwise. Contrasts the consequence of discounting, not an extra outcome.

Counterfactual: b discounts for sales-funded provision, reserves, other donors and partner capacity. u separately discounts households that would obtain a crib anyway, follow safe sleep without the intervention, continue unsafe practices or receive equipment after much of the risk period. r is not the mortality risk of every child reached; it applies to the higher-risk behavior-changing subgroup. A crib that replaces another safe surface has no modeled mortality benefit.

Attribution: Central a=.5 is a cautious allocation prior motivated by the recipient's material-resource program versus education/collaboration portfolio, not an audited restricted-donation split. Full cost c is not obtained by dividing national net expense by all partner shipments. Teaching included in the package is counted only through u; separate hospital certification, public messaging and research benefits remain unquantified. The central is therefore a conditional conservative pathway scenario, not a complete measured portfolio total or guaranteed lower bound.

The causal chain is credible but weakly quantified for this recipient. No trial establishes deaths prevented per donated crib. Behavior-changing infants' risk, sustained adherence and the next donation's allocation dominate. Joint favorable/pessimistic cases are stress tests, not probability intervals. Unquantified hospital/system benefits could dominate, but their causal access and marginal funding bridge must be separately established. Misassembly, added padding or displacement to sofas could reduce or reverse benefit; no claim that equipment is risk-free.

Sensitivity

• At central a,b,u,L,g and c=$500, meeting$100,000 per10 requires a per-changed-infant risk difference r×e≥.03741; meeting$1million requires≥.003741. Central r×e=.001 meets neither; these required differences exceed central total risk.
• At central health and additionality assumptions, maximum c is about$13.37 for$100,000 per10 and$133.65 for$1million. A bare product quote is not a supported-package cost.
• Reducing b from.5 to.1 raises the central price fivefold. An organization with a positive sales margin may have plenty of inventory but still need specific last-mile delivery funding; an actual marginal budget would distinguish these cases.
• Crib-use rates over90% cannot substitute for u=.2. Partial bed-sharing, added soft items and provision after peak risk materially reduce effective coverage.
• With r×e=.00015, central price is about$24.9million per10. Low-hazard bed-sharing risk is debated; high relative odds do not imply large absolute benefits for every family.
• Crediting the unmodeled education/system pathway would lower the price if it truly adds health. At a$1million threshold, it must add at least.07327 USA QALY per calculation unit beyond this central material pathway; that is a testable funding-to-outcome gap, not an assumed benefit.
• At central settings, undiscounted75-QALY life valuation yields about$1.35million per10, compared with$3.74million under27 discounted QALYs.
• Any adverse change in sleep arrangements or equipment misuse could erase benefit. CPSC guidance requires appropriate products and setup; no mortality reduction is inferred from distribution alone.
• In the PRAMS study, Cribs for Kids designation aORs were1.16(.86–1.56) for back sleep,1.06(.86–1.30) for separate surface,1.07(.87–1.31) for no soft bedding and.91(.75–1.12) for room sharing without bed sharing. These are observational conditional associations, not zero-effect proof; none supports a precise positive mortality conversion.

Unresolved inputs

• A current national unrestricted marginal budget separating extra donated packages, sales-funded operating costs, education/certification expansion and reserves.
• Current package procurement, shipping, instruction, follow-up and support cost; price list is unavailable publicly because of tariffs.
• A linked recipient cohort with pre-existing safe surface, actual alternative purchase/support, delivery age and repeated observed or validated sleep practice through the risk period.
• Baseline remaining sleep-related mortality risk for the behavior-changing subgroup, including smoking/substance exposure and infant age, not only demographic averages.
• Causal risk reduction from this actual intervention, with competing causes, unsafe substitution and adverse product-use behavior included.
• Additional hospital births whose sleep practices improve because of national unrestricted funding, net of hospital/public requirements and other campaigns.
• Outcome-weighted50states/DC residence share for domestic and overseas activities.
• Reconciliation of fiscal-year versus calendar-year accomplishment dates and grant launch/award counts; do not treat all return narrative counts as contemporaneous completed deliveries.