Enthea best-guess cost-effectiveness model

	A	B	C	D	E	F	G
1		Input	Input value (best-guess)	Input value (optimistic)	Input value (pessimistic)	Source	Notes

2	Costs
3
4		Ballot initiative
5		Setup costs	$50,000	$50,000	$100,000	guess
6		Polling	$100,000	$50,000	$300,000	private
7		Signature collection	$2,480,000	$2,000,000	$3,200,000	Ballotpedia
8		Advertising & late-stage operations	$12,000,000	$4,000,000	$35,000,000	SacBee analysis	See chart at bottom of article
9		Total cost of ballot initiative campaign	$14,630,000	$6,100,000	$38,600,000
10
11
12	Benefits
13
14		Depression
15		Number of people (18+) who had a major depressive episode in CA in 2015	1,731,000	1,731,000	1,731,000	NSDUH 2015 survey
16		Percent of depressed people who seek treatment	57%	57%	57%	Thornicroft et al. 2017	See USA results in table on p. 3, column B * column C
17		Number of CA people who sought treatment for their depression	991,448	991,448	991,448	calculation
18		Percent of treatment-seekers who would try psilocybin treatment, if it were approved	44%	63%	25%	YouGov 2017 survey	Best-guess assumes all of the "definitely would" respondents and half of the "probably would" respondents would use psychedelics if approved.
19		Percent who no longer meet BDI criteria for severe major depression after psilocybin treatment	33%	33%	33%	Carhart-Harris et al. 2016	Carhart-Harris et al. 2016 – 12 patients, 9 severely depressed at baseline. 4 score as "not depressed", 4 score as "moderately depressed", 1 scores as "severely depressed" at 3 months post-treatment. See fig. 4 of Carhart-Harris et al. 2016
20		Percent who BDI depression criteria was reduced from "severe" to "moderate" after psilocybin treatment	33%	33%	33%	Carhart-Harris et al. 2016	Carhart-Harris et al. 2016 – 12 patients, 9 severely depressed at baseline. 4 score as "not depressed", 4 score as "moderately depressed", 1 scores as "severely depressed" at 3 months post-treatment. See fig. 4 of Carhart-Harris et al. 2016
21		Replicability adjustment	20%	30%	10%	guess	Best-guess is about the same as GiveWell's 2017 replicability adjustment for deworming
22		Number of CA depressed people who would no longer meet BDI criteria for major depression after psilocybin treatment	29,082	62,461	8,262	calculation
23		Number of CA depressed people who would move from BDI criteria for "severe" major depression to BDI criteria for "moderate" major depression after psilocybin treatment	29,082	62,461	8,262	calculation
24		2015 DALYs averted by moving from "severe major depressive disorder" to no depression (per person per year)	0.658	0.658	0.658	2015 GBD DALY weights
25		2015 DALYs averted by moving from "severe major depressive disorder" to "moderate major depressive disorder" (per person per year)	0.262	0.262	0.262	calculation	See "Supplemental calculations" sheet
26		Number of CA DALYs / year from depression	300,422	300,422	300,422	calculation	See "Supplemental calculations" sheet
27		DALYs per person per year from depression	0.17	0.17	0.17	calculation
28		Major depression DALYs removed / year by psilocybin treatment	7,057	15,157	2,005	calculation
29
30		Alcoholism
31		Number of people (18+) with alcohol use disorder (AUD) in CA in 2015	2,038,000	2,038,000	2,038,000	NSDUH 2015 survey
32		Percent of AUD drinkers who attempted to quit in the last year	50%	60%	33%	guess	(Need a source for this!)
33		Percent of attempting quitters who failed to quit	90%	90%	90%	Atlantic article on AA	(Need a better source for this!) “Peer reviewed studies peg the success rate of AA somewhere between five and 10 percent,” writes Dodes. “About one of every 15 people who enter these programs is able to become and stay sober.”
34		Number of CA people (18+) who attempted to quit drinking and failed	917,100	1,100,520	605,286	calculation
35		Percent of treatment-seekers who would try psilocybin treatment, if it were approved	44%	63%	25%	YouGov 2017 survey	Best-guess assumes all of the "definitely would" respondents and half of the "probably would" respondents would use psychedelics if approved.
36		Percent who successfully stop drinking after psilocybin treatment	50%	50%	50%	Bogenschutz et al. 2015	Not confident I'm interpreting this study result correctly
37		Replicability adjustment	20%	30%	10%	guess	Best-guess is about the same as GiveWell's 2017 replicability adjustment for deworming
38		Number of AUD drinkers who would successfully quit drinking after psilocybin treatment	40,352	103,999	7,566	calculation
39		2015 DALY burden of alcohol use in CA	222,512	222,512	222,512	calculation	See "Supplemental calculations" sheet
40		DALY burden per CA drinker per year	0.1091814093	0.1091814093	0.1091814093	calculation
41		Alcohol DALYs removed / year by psilocybin treatment	4,406	11,355	826	calculation
42
43		Tobacco smoking
44		Number of people (18+) who smoked a cigarette in the last month in CA in 2015	4,706,000	4,706,000	4,706,000	NSDUH 2015 survey
45		Percent of smokers who attempted to quit in the last year	55.40%	55.40%	55.40%	CDC webpage
46		Percent of attempting quitters who failed to quit	90%	90%	90%	CDC webpage
47		Number of CA people (18+) who attempted to quit smoking and failed	2,346,412	2,346,412	2,346,412	calculation
48		Percent of treatment-seekers who would try psilocybin treatment, if it were approved	44%	63%	25%	YouGov 2017 survey	Best-guess assumes all of the "definitely would" respondents and half of the "probably would" respondents would use psychedelics if approved.
49		Percent who successfully abstain from smoking after psilocybin treatment	67%	67%	67%	Johnson et al. 2017
50		Replicability adjustment	20%	30%	10%	guess	Best-guess is about the same as GiveWell's 2017 replicability adjustment for deworming
51		Number of people who would successfully quit smoking after psilocybin treatment	138,344	297,126	39,302	calculation
52		2015 DALY burden of smoking in CA	343,207	343,207	343,207	calculation	See "Supplemental calculations" sheet
53		DALY burden per smoker per year	0.07292959303	0.07292959303	0.07292959303	calculation
54		Smoking DALYs removed / year by psilocybin treatment	10,089	21,669	2,866	calculation
55
56		Post-traumatic stress disorder
57		Number of people with PTSD in CA in a given year	971,835	971,835	971,835	calculation	See "Supplemental calculations" sheet
58		Percent of PTSD sufferers who seek treatment	57%	57%	57%	Thornicroft et al. 2017	See USA results in table on p. 3, column B * column C (assumed to be the same as with depression)
59		Number of people with PTSD in CA who sought treatment in a given year	556,628	556,628	556,628	calculation
60		Percent of treatment-seekers who would try MDMA treatment, if it were approved	44%	63%	25%	YouGov 2017 survey	Best-guess assumes all of the "definitely would" respondents and half of the "probably would" respondents would use psychedelics if approved.
61		Percent who no longer meet clincal definition of PTSD after MDMA treatment (placebo-adjusted)	58.33%	58.33%	58.33%	Mithoefer et al. 2010	"Likewise, 10 [of 12] of the MDMA group no longer met DSM-IV criteria for PTSD compared with two of the placebo group [2 of 8]."
62		Replicability adjustment	20%	30%	10%	guess	Best-guess is about the same as GiveWell's 2017 replicability adjustment for deworming
63		Number of CA people with PTSD removed after MDMA treatment	28,574	61,368	8,117	calculation
64		2015 DALYs averted by removing PTSD (per person per year)	0.17	0.17	0.17	calculation	See "Supplemental calculations" sheet; assumes PTSD DALY weight is the same as major depression, as the 2015 GBD DALY weights don't have an entry for PTSD
65		PTSD DALYs removed / year by MDMA treatment	4,959	10,651	1,409	calculation
66
67
68		Sum of benefits
69		Depression + alcoholism + smoking + PTSD DALYs averted per year	26,511	58,832	7,106	calculation
70		"Aggressive behavior" discount	25,822	57,302	6,921	Carbonaro et al. 2016	A survey of recreational psychedelic users who had bad trips found that 2.6% of them acted aggressively during their trip. We use this figure as a rough estimate of the proportion of patients who would not receive any benefit from psychedelic treatment.
71		Years of benefit before psilocybin & MDMA would be widely available by other means	5	10	2	guess
72		Total DALYs averted over timespan considered	129,110	573,020	13,843	calculation
73		Percent of impact attributable to the ballot initiative campaign	30%	45%	5%	guess
74		Probability that initiative succeeds, conditional on polling well & receiving sufficient funding	80%	90%	60%	private / guess	Private polls we have seen suggest that a drug liberalization ballot intiative would be very popular in most US states.
75		Total DALYs averted, in expectation	30,986	232,073	415
76
77
78	Cost per DALY averted
79
80		Total cost of a CA ballot initiative campaign	$14,630,000	$6,100,000	$38,600,000
81		Total DALYs averted, in expectation	30,986	232,073	415
82
83		Cost per DALY averted	$472	$26	$92,950
84
85
86
87
88
89
90		Benefits not modeled
91		Many of the benefits of the initative (plausibly including the most important) are difficult to model. Some benefits not included in this analysis:
92
93		(for psychedelic users) Alleviation of mild depression and anxiety
94		(for psychedelic users) Anti-addiction aid for behavioral addictions (gambling, online gaming, social media, etc.)
95		(for psychedelic users) Improved psychological openness
96		(for psychedelic users, speculative) Improved relationships between friends, co-workers, and significant others
97		(for psychedelic users, speculative) Improved self-efficacy
98		(societal) Reduced sentences for drug offenders
99		(societal) Increased personal liberty
100		(societal) Pushing US federal drug policy towards a public health model (i.e. away from a crime model)