Enthea minimum-benefit cost-effectiveness model
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Input
Input value (best-guess)
Input value (optimistic)
Input value (pessimistic)
SourceNotes
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Costs
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Ballot initiative
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Setup costs$50,000$50,000$100,000guess
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Polling$100,000$50,000$300,000private
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Signature collection$2,480,000$2,000,000$3,200,000Ballotpedia
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Advertising & late-stage operations$12,000,000$4,000,000$35,000,000SacBee analysisSee chart at bottom of article
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Total cost of ballot initiative campaign$14,630,000$6,100,000$38,600,000
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Benefits
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Depression
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Number of people (18+) who had a major depressive episode in CA in 20151,731,0001,731,0001,731,000NSDUH 2015 survey
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Percent of depressed people who seek treatment57%57%57%Thornicroft et al. 2017See USA results in table on p. 3
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Number of CA people who sought treatment for their depression991,863991,863991,863calculation
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Percent of treatment-seekers who would try psilocybin treatment, if it were approved44%63%25%YouGov 2017 surveyBest-guess assumes all of the "definitely would" respondents and half of the "probably would" respondents would use psychedelics if approved.
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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
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Percent who BDI depression criteria was reduced from "severe" to "moderate" after psilocybin treatment33%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
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Replicability adjustment20%30%10%guessBest-guess is about the same as GiveWell's 2017 replicability adjustment for deworming
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Number of CA depressed people who would no longer meet BDI criteria for major depression after psilocybin treatment29,09562,4878,266calculation
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Number of CA depressed people who would move from BDI criteria for "severe" major depression to BDI criteria for "moderate" major depression after psilocybin treatment29,09562,4878,266calculation
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2015 DALYs averted by moving from "severe major depressive disorder" to no depression (per person per year)0.6580.6580.6582015 GBD DALY weights
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2015 DALYs averted by moving from "severe major depressive disorder" to "moderate major depressive disorder" (per person per year)0.2620.2620.262calculationSee "Supplemental calculations" sheet
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Number of CA DALYs / year from depression300,422300,422300,422calculationSee "Supplemental calculations" sheet
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DALYs per person per year from depression0.170.170.17calculation
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Major depression DALYs removed / year by psilocybin treatment7,06015,1632,006calculation
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Alcoholism
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Number of people (18+) with alcohol use disorder (AUD) in CA in 20152,038,0002,038,0002,038,000NSDUH 2015 survey
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Percent of AUD drinkers who attempted to quit in the last year50%60%33%guess(Need a source for this!)
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Percent of attempting quitters who failed to quit90%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.”
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Number of CA people (18+) who attempted to quit drinking and failed917,1001,100,520605,286calculation
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Percent of treatment-seekers who would try psilocybin treatment, if it were approved44%63%25%YouGov 2017 surveyBest-guess assumes all of the "definitely would" respondents and half of the "probably would" respondents would use psychedelics if approved.
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Percent who successfully stop drinking after psilocybin treatment50%50%50%Bogenschutz et al. 2015Not confident I'm interpreting this study result correctly
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Replicability adjustment20%30%10%guessBest-guess is about the same as GiveWell's 2017 replicability adjustment for deworming
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Number of AUD drinkers who would successfully quit drinking after psilocybin treatment40,352103,9997,566calculation
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2015 DALY burden of alcohol use in CA222,512222,512222,512calculationSee "Supplemental calculations" sheet
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DALY burden per CA drinker per year0.10918140930.10918140930.1091814093calculation
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Alcohol DALYs removed / year by psilocybin treatment4,40611,355826calculation
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Tobacco smoking
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Number of people (18+) who smoked a cigarette in the last month in CA in 20154,706,0004,706,0004,706,000NSDUH 2015 survey
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Percent of smokers who attempted to quit in the last year55.40%55.40%55.40%CDC webpage
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Percent of attempting quitters who failed to quit90%90%90%CDC webpage
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Number of CA people (18+) who attempted to quit smoking and failed2,346,4122,346,4122,346,412calculation
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Percent of treatment-seekers who would try psilocybin treatment, if it were approved44%63%25%YouGov 2017 surveyBest-guess assumes all of the "definitely would" respondents and half of the "probably would" respondents would use psychedelics if approved.
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Percent who successfully abstain from smoking after psilocybin treatment67%67%67%Johnson et al. 2017
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Replicability adjustment20%30%10%guessBest-guess is about the same as GiveWell's 2017 replicability adjustment for deworming
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Number of people who would successfully quit smoking after psilocybin treatment138,344297,12639,302calculation
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2015 DALY burden of smoking in CA343,207343,207343,207calculationSee "Supplemental calculations" sheet
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DALY burden per smoker per year0.072929593030.072929593030.07292959303calculation
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Smoking DALYs removed / year by psilocybin treatment10,08921,6692,866calculation
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Post-traumatic stress disorder
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Number of people with PTSD in CA in a given year971,835971,835971,835calculationSee "Supplemental calculations" sheet
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Percent of PTSD sufferers who seek treatment57%57%57%Thornicroft et al. 2017See USA results in table on p. 3, assumed to be the same proportion as with depression
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Number of people with PTSD in CA who sought treatment in a given year556,862556,862556,862calculation
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Percent of treatment-seekers who would try psilocybin treatment, if it were approved44%63%25%YouGov 2017 surveyBest-guess assumes all of the "definitely would" respondents and half of the "probably would" respondents would use psychedelics if approved.
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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]."
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Replicability adjustment20%30%10%guessBest-guess is about the same as GiveWell's 2017 replicability adjustment for deworming
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Number of CA people with PTSD removed after MDMA treatment28,58661,3948,121calculation
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2015 DALYs averted by removing PTSD (per person per year)0.170.170.17calculationSee "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
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PTSD DALYs removed / year by MDMA treatment4,96110,6551,409calculation
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Sum of benefits
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Depression + alcoholism + smoking + PTSD DALYs averted per year26,51658,8427,108calculation
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Years of benefit before psilocybin & MDMA would be widely available by other means5102guess
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Total DALYs averted over timespan considered132,582588,42414,215calculation
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Percent of impact attributable to the ballot initiative campaign
30%45%5%guess
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Probability that initiative succeeds, conditional on polling well & receiving sufficient funding80%90%60%private / guessPrivate polls we have seen suggest that a drug liberalization ballot intiative would be popular in most US states.
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Total DALYs averted, in expectation31,820238,312426
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Cost per DALY averted
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Total cost of a CA ballot initiative campaign$14,630,000$6,100,000$38,600,000
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Total DALYs averted, in expectation31,820238,312426
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Cost per DALY averted$460$26$14,304
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Benefits not modeled
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Many of the benefits of the initative (plausibly including the most important) are difficult to model. Some benefits not included in this analysis:
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(for psychedelic users) Alleviation of mild depression and anxiety
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(for psychedelic users) Anti-addiction aid for behavioral addictions (gambling, online gaming, social media, etc.)
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(for psychedelic users) Improved psychological openness
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(for psychedelic users, speculative) Improved relationships between friends, co-workers, and significant others
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(for psychedelic users, speculative) Improved self-efficacy
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(societal) Reduced sentences for drug offenders
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(societal) Increased personal liberty
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(societal) Pushing US federal drug policy towards a public health model (i.e. away from a crime model)
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