Help America Hear

Ordinary unrestricted recipient support, with all recipient fundraising, operations and scholarships retained in the planning cost. G=$10,000 is normalization only. c=$3,000 is a conditional full-support cash-cost prior anchored to gross expenses less identifiable donated aids divided by a conservative120-patient denominator; this ratio is not a verified production function. Patient tests, travel and fitting costs and donated provider/device resource costs are separately disclosed, not claimed free to society.

Official program and return describe nationwide domestic services and no foreign operations. Conditional g=.99 allows incidental nonresident benefit; range.98–1. USA includes residents of50states and DC. Headquarters location and citizenship are not allocation keys.

D=sum[t=1..T]((1−m)/1.03)^t. N=(G/c)×b. Q_all=N×(s×u×p×D−h). Q_USA=Q_all×g. Price per10=10G/Q_USA only if positive. b is financing/provider/manufacturer additionality; s is benefit not otherwise obtained; p is sustained effective use; u is utility gain while using devices. h is an adverse-burden allowance retained for all additional fittings even when s=0. Central inputs are explicit judgments, with wide sensitivity tests.

G

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

FY2025 gross accounting expense

426522 USD (observed). 278776 PartIX +147746 PartVIII direct event costs; no asset-sale basis treated as operating expense. [hah-99025]

FY2025 donated aids

123000 USD recorded fair value (observed). ScheduleM164items; matching expense line. Book value is not benefit or replacement cost. [hah-noncash] [hah-99025]

Historical recipient count floor

120 people (observed). Narrative says over120;120 used only as conservative denominator, not exact matched fitting count. [hah-99025]

c

3000 USD/marginal completed fitting (judgment). We adopt $3,000 per supported fitting, rounded up from the historical non-in-kind diagnostic, and 60% financing/capacity additionality. Existing last-resort fitting capacity and modest reserves support a nonzero response, while the 40% discount allows sponsor and provider constraints. These are judgments, not measured marginal rates. [hah-99025] [hah-noncash] [hah-program]

b

0.6 financing and capacity additionality (judgment). We adopt $3,000 per supported fitting, rounded up from the historical non-in-kind diagnostic, and 60% financing/capacity additionality. Existing last-resort fitting capacity and modest reserves support a nonzero response, while the 40% discount allows sponsor and provider constraints. These are judgments, not measured marginal rates. [hah-99025] [hah-program]

s

0.7 fraction of benefit not otherwise available (judgment). Last-resort screening supports targeting; allow30% alternative access/benefit. Range0–.9. OTC alternatives do not cover all ages/severities. [hah-program] [hearing-medicare] [hearing-otc]

u

0.04 QALY/year while effectively aided (judgment). One-third of Singapore.12 short-term HUI difference, discounted for modified scoring and generic-US composite nulls. Stress0–.10; not an HHIE-to-QALY mapping. [hearing-utility] [hearing-generic] [hearing-communication]

p

0.75 effective sustained-use fraction (judgment). Allows nonuse, partial use, poor fit, maintenance and limited follow-up. Range.5–.9. Not a measured recipient adherence rate. [hah-faq] [hearing-utility]

T

4 years (judgment). Conditional four-year benefit; evidence supports three-year communication effect and program allows application everyfiveyears, but that is not proof of durability. Range1–5. [hearing-communication] [hah-program]

m

0.02 annual competing mortality probability (judgment). Broad mixed-age allowance; actual age mix absent. Range.01–.04; no mortality benefit credited.

h

0.001 QALY/additional fitting (judgment). Small acclimation/discomfort/adverse burden allowance, not an observed serious-harm rate; test0–.002. Retained when alternative benefit offsets hearing gains. [hearing-cognition] [hah-program]

g

0.99 USA resident health share (judgment). Domestic mission and operations; outcome-weighted residence unknown. Range.98–1. [hah-program] [hah-99025]

Best estimate — explicit judgment: Cost: $10K; USA QALYs: 0.14511181107982615; all-population QALYs: 0.14657758694931936. c=3000; b=0.6; s=0.7; u=0.04; p=0.75; T=4; m=0.02; D=3.5375615940314136; h=0.001; g=0.99. Hearing/function only; no mortality or dementia prevention credited. We adopt $3,000 per supported fitting, rounded up from the historical non-in-kind diagnostic, and 60% financing/capacity additionality. Existing last-resort fitting capacity and modest reserves support a nonzero response, while the 40% discount allows sponsor and provider constraints. These are judgments, not measured marginal rates.

Cautious fitted-device hearing/function model: Cost: $10K; USA QALYs: 0.14511181107982615; all-population QALYs: 0.14657758694931936. c=3000; b=0.6; s=0.7; u=0.04; p=0.75; T=4; m=0.02; D=3.5375615940314136; h=0.001; g=0.99. Hearing/function only; no mortality or dementia prevention credited.

Efficient coordination with durable otherwise-unavailable hearing benefit: Cost: $10K; USA QALYs: 4.624568735488061; all-population QALYs: 4.624568735488061. c=700; b=0.9; s=0.9; u=0.1; p=0.9; T=5; m=0.01; D=4.446773820084557; h=0.0005; g=1. Hearing/function only; no mortality or dementia prevention credited.

Short use, alternatives and adverse burden: Cost: $10K; USA QALYs: -0.0002949514563106797; all-population QALYs: -0.0003009708737864078. c=4000; b=0.2; s=0.3; u=0.01; p=0.5; T=1; m=0.04; D=0.9320388349514562; h=0.002; g=0.98. Hearing/function only; no mortality or dementia prevention credited.

Manufacturer or provider capacity fixed: Cost: $10K; USA QALYs: 0; all-population QALYs: 0. c=3000; b=0; s=0.7; u=0.04; p=0.75; T=4; m=0.02; D=3.5375615940314136; h=0.001; g=0.99. Hearing/function only; no mortality or dementia prevention credited.

Equivalent hearing achieved elsewhere: Cost: $10K; USA QALYs: -0.00198; all-population QALYs: -0.002. c=3000; b=0.6; s=0; u=0.04; p=0.75; T=4; m=0.02; D=3.5375615940314136; h=0.001; g=0.99. Hearing/function only; no mortality or dementia prevention credited.

No QALY gain under generic quality-of-life measure: Cost: $10K; USA QALYs: 0; all-population QALYs: 0. c=3000; b=0.6; s=0.7; u=0; p=0.75; T=4; m=0.02; D=3.5375615940314136; h=0; g=0.99. Hearing/function only; no mortality or dementia prevention credited.

Counterfactual: The financial screen makes otherwise-unmet need plausible but does not prove no alternative care. s allows Medicare Advantage, Medicaid, veterans' programs, other charities, family purchase or suitable OTC options. b separately discounts existing sponsorship, fixed donated-device quotas, provider slots and reserves. c includes failed applications/administration through the whole-recipient historical anchor; p discounts post-fitting use, not completion twice.

Attribution: No extra hearing gain is credited to both scholarship and standard-program recipients. Scholarship cash and awareness receive no assumed health benefit but remain in cost; their separate benefits are unquantified. Each recipient is counted once, not once per device. Clinical priors transfer from external trials with better follow-up, not from device retail values. The main uncertainty is donation-sensitive completed care, so numerical cases are conditional and do not establish a favorable bound.

We adopt $3,000 per supported fitting, rounded up from the historical non-in-kind diagnostic, and 60% financing/capacity additionality. Existing last-resort fitting capacity and modest reserves support a nonzero response, while the 40% discount allows sponsor and provider constraints. These are judgments, not measured marginal rates. Zero and adverse outcomes remain possible; the quantified pathway is not a complete portfolio valuation.

Sensitivity

• At conditional clinical inputs and c=$3000, achieving$1million per10 requires b≥.4135; achieving$100000 requires b≥4.135, impossible. Lower costs or larger sustained clinical benefit are required for the tighter threshold.
• At b=.6 and other conditional inputs, c must be≤$4353 for$1million per10 or≤$435 for$100000 per10. A free manufacturer device alone does not establish either full-support cost.
• At c3000 and b.6, annual effective-use utility u must be≥.02773 for$1million per10 or≥.27248 for$100000. Generic quality-of-life nulls make the former uncertain; the latter exceeds the adopted hearing-utility evidence.
• The best estimate uses judgmental funding-sensitive fittings; current observed marginal capacity would improve it. Zero manufacturer/provider capacity expansion means b=0.
• Adding$1325 percase as an illustrative resource allowance for donated devices and external fitting/testing support increases the conditional social-cost price by44%, to about$993000 per10. This is not a procurement quote; actual donated opportunity cost and patient expenses are missing.
• Reducing benefit to one year, or substantial failure to obtain replacement/repairs after the included service year, erodes most of the four-year gain.
• No dementia, survival, earnings or scholarship-value addition is made. Communication points and device market values cannot be added to QALYs.
• Current webpage deposit terms and FAQ fee/income language conflict. If up-front costs exclude the poorest or reduce completed care, historical referral counts overstate reachable benefit.
• Case-mix and current donation allocation could differ from historical120-person volume. The whole-recipient model intentionally retains event and scholarship costs instead of pricing only the best donated-device episode.

Unresolved inputs

• Current marginal budget linking unrestricted donations to otherwise-unfunded completed fittings, with confirmed manufacturer quantities and professional appointments.
• Reconciled person/device/cohort counts, scholarship overlap, inventory movement and cost of failed applications or missing follow-up.
• Current application fee/deposit and income-tier terms; patient testing, travel, batteries, repair and fitting costs.
• Recipient hearing severity, age and previous/alternative aid access; repeated measured hearing-function, utility and device-use data.
• Long-term follow-up and repair/replacement capacity after the included service period.
• Original-registry verification of a CauseIQ CA registration flag ('Dissolution Pending', as ofJune3,2026). This is unverified, may concern CA registration only, and is not evidence of national closure; current official program remains live.
• Outcome-weighted50states/DC residence and manufacturer/provider opportunity cost.