GiveWell analysis of SCI's cost per treatment - November 2016 update
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For full context, see GiveWell's review of SCI
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Note: Analysis primarily as of October 2014; small updates in 2015 and 2016
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Summary of Cost per Treatment Estimates
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More details and source notes are below
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Grey text color indicates formula does currency conversion.
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Cost per treatmentCost per treatment, excluding drugs, including government costsCost per treatment, including drugs, excluding government costsCost per treatment, excluding drugs and government costs% of costs (for reference across estimates)TreatmentsGBP CostsUSD Costs
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Estimate fromGBPUSDGBPUSDGBPUSDGBPUSDSCI costs, excluding drugsDrug costsGovernment costsTotal costsTotal treatmentsSCI costs, excluding drugsDrug costsGovernment costsTotal costsSCI costs, excluding drugsDrug costsGovernment costsTotal costs
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SCI's programs, 2010-2016£0.76$1.19£0.54$0.84£0.53$0.83£0.31$0.4941%29%30%100%67,329,321£21,059,564£14,903,269£15,412,643£51,375,475$32,760,089$23,183,406$23,975,784$79,919,279
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SCI's programs 2010-2016, including research costs£0.82$1.28£0.60$0.93£0.57$0.89£0.35$0.5543%27%30%100%67,329,321£23,797,991£14,903,269£16,586,254£55,287,515$37,019,965$23,183,406$25,801,445$86,004,816
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In the below sections, bold lines are numbers that are referenced in the summary table above
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Drug costs (praziquantel)
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To calculate drug costs, we focus on the data we have available, primarily purchases by Crown Agents as part of the ICOSA program funded by DFID. Note, we use the same value for all programs, though the price has increased over the last 10 years.
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SCI stated that 20 pence per treatment, which lines up with our analysis when excluding wastage, is a reasonable estimate. "Praziquantel leaving the factory gate was as low as 7 cents per tablet 10 years ago. Now it is 10 cents per tablet. That is cents not pence. With insurance and shipping the cost at the receiving country is about 12 cents - or taking a 1.66 exchange rate say 8 pence per tablet = 20 pence per child at 2.5 tablets on average." Alan Fenwick, SCI Director, email to GiveWell, October 23, 2014
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DataSourceNotes
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Total spend£10,135,290
Crown Agents Total ICOSA Procurement Spend (updated 2014)
The units in the source file are not labelled. We have assumed the figures are in GBP.
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Total number of tablets procured and delivered by March 2014127,191,000
SCI ICOSA Mid-Year Report 2014, Pg 12 (Table 3).
This includes a large number of tablets held in reserve and not yet delivered as of March 2014.
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Drug cost per tablet£0.08
GiveWell calculation.
For reference, today this is about: $0.11.
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Wastage assumption10%GiveWell judgment.
This is the percentage of drugs we assume are wasted. We do not have data on actual wastage so are intuitively hypothesizing what seems reasonable. We note that a similar assumption was discussed in an paper we found (Utroska et al. 1989), though this is quite dated and we do not know how the authors arrived at 10%.
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Drug costs per tablet, accounting for wastage£0.09
GiveWell calculation.
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Average number of tablets per treatment2.5
SCI ICOSA Mid-Year Report 2014, Pg 12.
This is consistent with a variety of other sources.
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Drug costs per treatment, accounting for wastage£0.22
GiveWell calculation.
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Government costs
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For all of our analysis, we use a uniform percentage of total costs to estimate the share of the costs that the government incurs.
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Sources and notes: See "Shortcomings on our analysis" section section of review on SCI: http://www.givewell.org/node/2365#Shortcomingsofouranalysis
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Government's share of total treatment costs30%
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SCI's recent programs, SCI costs
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Time period: First six years of program (October 2010 through March 2016). See notes for exceptions.
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Programs included: for full time period- Cote d'Ivoire, Liberia (except for 2015-16), Malawi, Mozambique, Niger, Tanzania, Uganda (except 2015-16), Zambia, and Zanzibar (except for 2015-16); starting in 2014- Ethiopia and DRC; starting in 2015 - Madagascar, Yemen
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DataSourceNotes
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USD per GBP, FY1-FY61.56
GiveWell calculation.
For simplicity, taking the simple average of yearly average GBP/USD rate from 2011 through 2016 (for FY1-FY6 spending).
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Schistosomiasis treatments, FY1-545,396,322
SCI report to DFID (September 2015), Pgs 12-13.
We believe this number does not include about 3 million treatments in both Ethiopia and Mozambique that were planned for FY5 (2014/2015) but were slightly delayed into the next year.
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Schistosomiasis treatments included in cost per treatment analysis, FY6 (2015-16)27,787,723
See "2015-16 treatment numbers" sheet. Original source: SCI Global treatment numbers 2015-16
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Adjustment rate for reported treatments0.92
GiveWell summary of SCI coverage surveys
Median adjustment factor for reported data
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Adjusted # of schistosomiasis treatments, FY1-667,329,321
GiveWell calculation
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DFID award, total (as of May 2014)£10,537,440
SCI advisory board financial report (June 2014), Slide 3
£10.5 million is reinforced by other documents. For example, see SCI ICOSA Mid-Year Report 2014, Page 4.
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DFID award, balance available (as of May 2014)£3,645,604
SCI advisory board financial report (June 2014), Slide 11
This appears to be the amount of the first DFID grant award that has not been spent as of May 2014. SCI ICOSA Mid-Year Report 2014 does not report total actual spending. We are unsure what "Approx £2 million remaining" (Slide 8 of same source) refers to.
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DFID award, spent (as of May 2014)£6,891,836GiveWell calculation
This is the implied amount of the £10.5 million grant from DFID that SCI had spent as of May 2014. Ideally, we would exclude April and May 2014 from this figure.
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Unrestricted funding, original ICOSA programs, program spending (through March 2014)
£643,050
GiveWell summary of SCI finances (October 2014), Sheet Combined with previous updates. GiveWell calculated the total from each of the 9 original program lines for each of the 3 time periods November 2011 through March 2014 and then converted from USD to GBP (for comparison with DFID spending).
We ignore unrestricted funds spent prior to November 2011, which we believe to be small (see details on unrestricted funding in SCI review).
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Unrestricted funding, HQ costs (through March 2014)£339,588
GiveWell summary of SCI finances (October 2014), Sheet Combined with previous updates. GiveWell calculated the total from the "operating costs" line item for each of the 3 time periods November 2011 through March 2014 and then converted from USD to GBP (for comparison with DFID spending).
It is possible that operating costs are just one part of HQ costs, but we don't know of other line items that clearly make sense to include.
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Unrestricted funding, total spend (through March 2014)£2,594,057
GiveWell summary of SCI finances (October 2014), Sheet Combined with previous updates. GiveWell calculated the total from the "total spending" line for each of the 3 time periods November 2011 through March 2014 and then converted from USD to GBP (for comparison with DFID spending).
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Unrestricted funding, % non-HQ costs, original ICOSA programs (through March 2014)
29%GiveWell calculation
For context, a large amount of the remaining 70% of unrestricted spending was spent in Ethiopia (about £1 million).
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Unrestricted funding, HQ costs, original ICOSA programs (through March 2014)£96,862GiveWell calculation
Allocating HQ costs to ICOSA under rough assumption that every £ of unrestricted (non-HQ) spending requires the same amount of HQ support.
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Unrestricted funding, total spend, original ICOSA programs (through March 2014)£739,912GiveWell calculation
It is possible this includes some drug purchases, which we'd ideally exclude here to avoid double counting. We expect it is unlikely any unrestricted funds have been used for this purpose given that DFID has allocated additional funding for drug purchases.
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Other funding, ICOSA program spend (through March 2014)£102,152
SCI advisory board financial report (June 2014), Slide 3
Vitol funded mapping in Cote d'Ivoire; we use "Expended (incl. commitments)" since (according to the same source) this mapping has been completed (so we don't expect there are outstanding commitments). Other than this, we are not aware of any other sources of funding going towards these programs.
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SCI's spending, Ethiopia + DRC, FY4 (2013/2014)£721,183
SCI financial statement 2013/14 and 2014/15 (revised October 2015), sheet Revised Fin Statement. Sum of relevant programs 2013/2014 total program expenditures
We believe this to be the most accurate source for these data. As a check, we had previously reported about GBP 900,000 spending of unrestricted funding in Ethiopia from Nov 2011 - March 2014, GiveWell summary of SCI finances (October 2014)
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Country expenditures, total, FY4 (2013/14)£3,021,975
SCI financial statement 2013/14 and 2014/15 (revised October 2015), sheet Revised Fin Statement.
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% country expeditures on Ethiopia + DRC programs, FY4 (2013/14)24%GiveWell calculation-
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Total central expenditures, FY4 (2013/14)£1,211,342
SCI financial statement 2013/14 and 2014/15 (revised October 2015), sheet Revised Fin Statement.
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Central expenditures for Ethiopia + DRC, FY4 (2013/14)£289,082GiveWell calculation
Allocating central expenditures under rough assumption that every £ of country expenditure requires the same amount of central support.
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SCI's spending in Ethiopia + DRC, excluding drugs, FY4£1,010,265GiveWell calculation
We are unsure but expect that spending in these two programs prior to FY4 was relatively small.
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SCI's spending, excluding drugs, FY1-4£8,744,166GiveWell calculation
SCI shared detailed monthly expenses with us (GiveWell analysis of SCI expense details 16 June 2014 (unpublished)), which show totals of £8.5 and £8.7 million spent in original nine ICOSA countries through April 2014. It is not clear to us what explains the difference compared to the ~£7 million we calculate here (excluding Ethiopia/DRC). However, it appears that a spreadsheet error double counts some line items, and correcting this reduces the total to £7.9 million (of which 0.1 million is in April 2014, which we'd exclude for comparison). If these inferences are incorrect and we are actually missing ~£1 million in costs, our cost per treatment is too low by about $0.06. Either way, the details give us some confidence that large buckets (e.g. of SCI salaries and spending through sub-contracts) are not excluded from our analysis. Note, It is possible that some of the difference includes costs we would want to exclude here (e.g. drug purchases, or research programs unrelated to these treatments).
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Country expenditures, ICOSA programs, FY5 (2014/15)£3,008,260
SCI financial statement 2013/14 and 2014/15 (revised October 2015), sheet Revised Fin Statement. Sum of relevant programs 2014/2015 total program expenditures
Using this report to update the previous reports on FY1-4 spending.
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Country expenditures, total, FY5 (2014/15)£3,714,172
SCI financial statement 2013/14 and 2014/15 (revised October 2015), sheet Revised Fin Statement.
We are not certain but believe that this spending does not include any drug costs (if it does, this cost is over-stated since drug costs are accounted for separately in this spreadsheet).
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% country expeditures on ICOSA programs, FY5 (2014/15)81%GiveWell calculation-
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Total central expenditures, FY5 (2014/15)£658,732
SCI financial statement 2013/14 and 2014/15 (revised October 2015), sheet Revised Fin Statement.
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Central expenditures for ICOSA programs, FY5 (2014/15)£533,534GiveWell calculation
Allocating central expenditures to ICOSA under rough assumption that every £ of country expenditure requires the same amount of central support.
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SCI's spending, excluding drugs, FY5 (2014/15)£3,541,794GiveWell calculation-
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Country expenditures, all programs included in cost per treatment analysis, FY6 (2015/16)
£5,531,007
GiveWell calculation. See "2015-16 costs and treatments" sheet
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Total central expenditures FY6 (2015/16)£1,284,719
"2015-16 BVA" sheet, cell L6
£0.28
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% of country expenditures on all programs included cost per treatment analysis, FY6 (2015/16)
88%GiveWell calculation
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Central expenditures for countries included in cost per treatment analysis, FY6 (2015/16)
£1,136,641GiveWell calculation
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SCI's spending included in the cost per treatment analysis, excluding drugs, FY 6 (2015/16)
£6,667,648GiveWell calculation
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SCI's spending, excluding drugs, FY1-6£18,953,608GiveWell calculation
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Portion of SCI's costs paid by Imperial College10%
GiveWell estimate, informed by GiveWell's non-verbatim summary of a conversation with Wendy Harrison and Najwa Al Abdallah on September 8, 2015
This is a rough estimate. Imperial College supports SCI, for example, covering some legal and administrative expenses. These are not included in SCI's reported spending. SCI told us that 6% of it's DFID grant was allocated to this but that it received more than that covered, so 10% seemed like a plausible estimate.
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SCI's total costs, excluding drugs£21,059,564
GiveWell calculation
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Cost per treatment for SCI, excluding drugs£0.31GiveWell calculation
For reference, SCI reported £0.40 per treatment (which we believe includes little or no drug costs) on the first three years of the ICOSA program (with ~12 million treatments delivered at that point): "This gives a direct financial cost per treatment of 40 pence. These figures are broadly representative of other implementation projects in SCI but do not include funds allocated to advocacy and fundraising." SCI report to GiveWell (September 2013), Pg 1.
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During the ICOSA programs, there has been additional spending on independently-funded operational research. We are not certain that these expenses did not lead to some of the treatments counted in the ICOSA programs (either directly, as part of the research projects, or indirectly through improved operations due to the research), so we look at these as possible additional costs to get a more conservative estimate.
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Operational research expenses, FY1-4£1,095,371
SCI advisory board financial report (June 2014), Slides 5, 17, 21. Sum of "actual spend" for SCORE and CIFF funding (from bar charts on slides 17 and 21) and "expended (incl. commitments)" (from table on slide 5) for Comic Relief (we did not have an estimate of how much of this was committed but not yet spent).
For reference, using current exchange rates this is about $1.5 million. We exclude the "Control of Cysticercosis" grant as it seems unlikely it led to deworming treatments. SCORE studies are in Niger and Mozambique, CIFF grant is in Liberia and Uganda, and Comic Relief funding is in Malawi.
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Operational research expenses, FY5£273,843
GiveWell assumption
Assume same annual research spending
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Operational research expenses, FY6£273,843
GiveWell assumption
Assume same annual research spending
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Costs for SCI, excluding drugs, including research£23,797,991
GiveWell calculation
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FX Rates
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Source: http://www.ozforex.com.au/forex-tools/historical-rate-tools/yearly-average-rates (accessed Sept 14, 2016 for "Compare British Pound Against US Dollar")
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YearUSD per GBP
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20031.635499
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20041.832895
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20051.820271
90
20061.842866
91
20072.00156
92
20081.855443
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20091.565394
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20101.545893
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20111.604123
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20121.584877
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20131.564768
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20141.647701
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20151.532283
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20161.3998
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Summary - SCI cost per treatment
GW 2015-16 costs and treatments
SCI 2015-16 treatment numbers
SCI 2015-16 BVA