Predictive CEA of Vida Plena 2024

	A	B	C	D	E
1	2024 CEA Estimates - Vida Plena
2		2024
3		Worse Case	Best Guess / Average	Best Case	Notes

4	Number of people treated
5	Target number of people to be treated by Vida Plena	5400	6000	6600	see calculations in the "participants" tab (includes dropout rate of 40%)
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7	Vida Plena Costs
8	Fixed costs (overhead)	$232,997	$211,815	$190,634	see budget
9	Variable cost per Person	$46	$42	$38	see budget
10	Total intervention costs	$482,477	$463,815	$440,114	fixed cost + cost per person (does not include start-up or impact study costs)
11	Total cost divide by number of treated	$89	$77	$67
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13	Details about Ecuador
14	Population in Ecuador (2019)	17,370,000	17,370,000	17,370,000	Our World in Data
15	# of people with depressive disorders in Ecuador (2019)	498,548	576,078	662,437	Global Burden of Disease (2019) - see related sheet
16	Fraction of depressed people reached by Program	1.08%	0	1.00%
17	Average household size in Ecuador	1.17	3.12	7.20	Using different sources about the average household size in Ecuador (see related tab), we linearly predict the average household size in 2022. Simulated confidence intervals based on the distributions provided by the UN data are used for the lower and upper values. Calculations are in R.
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19	Subjective Wellbeing analysis				See work by the Happier Lives institute (McGuire et al., 2022a)
20	Conversion rate to WELLBYs	2	2	2	We convert the values to wellbeing-adjusted life years (WELLBYs). A WELLBY represents a one point increase in life satisfaction for one year (or a combination of years and increase; two years with a 0.5 increase for example). This measure is easier to understand than SD-years and has a similar logic as DALYs. For more about WELLBYs, see McGuire et al. (2022b).
21	StrongMind's total effect overtime for an individual (standardised-deviation-years of wellbeing)	0.67	1.69	2.83	The total effect for the individual (including the long-term effects) of receiving psychotherapy. We assume that Vida Plena will have a similar effect than StrongMinds.
22	StrongMind's total effect overtime for an individual (WELLBYs)	1.34	3.38	5.66
23	Psychotherapy household spillovers	11.00%	53.00%	108.00%	The effects of psychotherapy spillover to the rest of the household. 53% of the effect on the individual is experienced by each other member in the household.
24	Overall effect for Vida Plena for a household (standardised-deviation-years of wellbeing)	0.68	3.59	21.78	Overall effect is calculated as effect on individual + effect on individual * household spillover * non-recipient household size
25	Overall effect for Vida Plena for a household (WELLBYs)	1.37	7.18	43.56	To convert from SD-years we use a typical standard deviation in life satisfaction questionnaires. In the World Happiness Reports the standard deviation is usually ~2 points.
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27	Adjustment for counterfactual of people that receive treatment	75.00%	75.00%	75.00%	75% of people in latin america do not receive treatment for mental health issues (Kohn et al., 2018).
28	Adjusted overall effect in WELLBYs	1.02	5.38	32.67	This imagines that the people who receive treatment other than VP will receive treatment that is as good, which is not the case.
29	Probability of Vida Plena success	75.00%	83.33%	95%	Based on the fact that 15 out of 18 charities in the incubator program succeeded.
30	Adjusted for probability of success	0.77	4.49	31.04
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32	Number of WELLBYs gained	4,146	26,917	204,838	Total number of WELLBYs gained from the program
33	Cost per WELLBY	$116.36	$17.23	$2.15	Cost to provide one WELLBY.
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35	Vida Plena number of WELLBYs per $1000 spent	8.6	58.0	465.4	For $1000 spent, how many WELLBYs are gained
36	StrongMinds number of WELLBYs per $1000 spent	16.1	71.3	224.6	For $1000 spent, how many WELLBYs are gained
37	GiveDirectly number of WELLBYs per $1000 spent	1.1	7.5	29.3	For $1000 spent, how many WELLBYs are gained
38	Vida Plena is x times more cost-effective than GiveDirectly	7.8	7.7	15.9	Vida Plena is more cost-effective than GiveDirectly
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40	DALY Information
41	Total DALYs in Ecuador (2019)	3,712,287	4,375,097	5,139,409	Global Burden of Disease (2019) - see related sheet
42	Depression DALYs in Ecuador (2019)	70,268	102,198	142,186	Global Burden of Disease (2019) - see related sheet
43	Disability Weight of the Burden of Depression	0.477	0.658	0.807	Global Burden of Disease (2019) - severe major depressive disorder
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45	DALY analysis of Strong Minds (Founders Pledge analysis)				See here and here
46	DALYs averted per person treated by Strong Minds	0.22	0.27	0.33	The effect of StrongMinds in DALYs was calculated by FP by stretching the disability weight for severe depression across the 27-point PHQ-9 scale (the depression scale used by StrongMinds). Founders Pledge estimated that g-IPT reduces the depression of a recipient by 3.13 PHQ-9 scores and that each year 75% this effect is retained, resulting in a total of 0.27 DALYs averted per recipient.
47	Adding counterfactual and success adjustment	0.13	0.17	0.24
48	DALYs alleviated in total by Strong Minds (total impact)	675.56	1,003.52	1,560.19
49	Dollars per DALY	$714.19	$462.19	$282.09
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51	Reference
52	Subjective Wellbeing: “good mental states, including all of the various evaluations, positive and negative, that people make of their lives, and the affective reactions of people to their experiences" (OECD, 2013). How happy or how satisfied people are with their lives.
53	Standard Deviations and SD-years: Meta-analyses typically report effects in standard deviations because they combine results from different studies on different measures. SD-years are the standard deviation gains over the years. In McGuire et al. (2022a), the long-term effects of psychotherapy are calculated over time. SD-years are not easy to interpret unless converted into another measure based on its typical standard deviation. However it can also be used to directly compare to another intervention evaluated in SD-years. For example, McGuire et al. (2022a) found that StrongMinds is 9 times more cost-effective than GiveDirectly.
54	Wellbeing adjusted life-years (WELLBYs): One WELLBY is one year with an increase in subjective wellbeing of one point on a 0-10 scale. Or any appropriate combination of time and increase (2 years with a 0.5 point increase). This is similar to DALYs except it uses subjective wellbeing reports from the people treated instead of surveys asking people to make judgments about how healthy they think a category or another is. Because wellbeing is ultimately what matters (health or income isn't intrinsically good, it is good for people in what it does for them), WELLBYs allow for comparisons across all sorts of interventions, not just health. For more on the strengths of WELLBYs for cost-effective analyses see McGuire et al. (2022b).
55	DALY: One DALY represents the loss of the equivalent of one year of full health. DALYs for a disease or health condition are the sum of the years of life lost to due to premature mortality (YLLs) and the years lived with a disability (YLDs) due to prevalent cases of the disease or health condition in a population.
56	Disability: a physical, mental, cognitive, or developmental condition that impairs, interferes with, or limits a person's ability to engage in certain tasks or actions or participate in typical daily activities and interactions
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58	Color Key
59	Input
60	Calculation
61	Subjective judgement
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