{
  "modelVersion": "0.1",
  "preparedOn": "2026-10-17",
  "budgetUSD": 100,
  "currencyYear": 2025,
  "estimateType": "Illustrative program-cost scenario; not an estimated return on a current donation",
  "population": "Adults with trachomatous trichiasis receiving an additional completed surgical treatment course; Ethiopian outcome evidence provisionally applied to a broader planning-cost reference.",
  "counterfactual": "No additional surgery in the credited year. Assumed average relief is relative to the care patients would otherwise receive, including self-care. This counterfactual was not measured by the longitudinal study.",
  "referenceIntensityHours": 47.25,
  "intensityExponent": 1,
  "creditedDays": 275,
  "creditedWindow": "Postoperative days 91 through 365 inclusive. Earlier disease-pain relief is uncredited; a separate early treatment-pain allowance is deducted.",
  "scope": "Later eye-pain relief minus an assumed early treatment-pain burden. Incomplete pain balance, not total net benefit.",
  "reportedEvidence": {
    "study": {
      "source": "T1",
      "year": 2017,
      "enrolledAdults": 1000,
      "followedAtOneYear": 980,
      "painReportedBeforePercentApprox": 99,
      "painReportedAtOneYearPercent": 33.7,
      "design": "Longitudinal surgical cohort with comparison participants without trichiasis, not surgery versus untreated trichiasis. Operations were randomized between techniques."
    },
    "cost": {
      "sources": [
        "T2",
        "T3"
      ],
      "baseCostUSD": 180,
      "implementationUplift": [
        0.5,
        1.0
      ],
      "derivedPlanningCostUSD": [
        270,
        360
      ],
      "currencyYear": 2025,
      "caveat": "Coalition planning average for TT management, which includes surgery and epilation. Not an audited surgery-only cost or a current provider quotation."
    },
    "funding": {
      "source": "T3",
      "publicationYear": 2025,
      "estimatedGapUSD": [
        105000000,
        140000000
      ],
      "estimatedCases": 390000,
      "countries": 13,
      "currentUnfundedBalanceVerified": false,
      "allocationOfNewDonationVerified": false
    }
  },
  "choices": {
    "costUnitBridge": "Use the coalition management cost as a proxy for one completed patient surgical course, including required eye care. Do not double count bilateral patients. Actual surgery mix, repeat procedures and full partner costs need confirmation.",
    "intensity": "WSI judgment about average attributable relief across all treated patients and all hours, including sleep, incomplete response and recurrence. Not derived from symptom percentages or a calibrated USU survey. No extra success-rate multiplier.",
    "duration": "WSI judgment; the one-year observation does not measure relief throughout the 275-day interval.",
    "recovery": "WSI allowance for additional treatment pain, applied to every modeled course. Days and intensity are not study estimates and do not fully price complications.",
    "additionality": "Conditional on additional completed surgical courses. No donor-allocation or marginal funding factor is estimated."
  },
  "scenarios": {
    "lower": {
      "label": "Lower",
      "costPerCourseUSD": 360,
      "averageIntensityReduction": 0.25,
      "recoveryDays": 14,
      "recoveryIntensity": 3,
      "courseEquivalents": 0.2777777777777778,
      "laterReliefUSU": 9.700176366843033,
      "recoveryBurdenUSU": 5.925925925925926,
      "selectedPainBalanceUSU": 3.7742504409171076
    },
    "central": {
      "label": "Central",
      "costPerCourseUSD": 315,
      "averageIntensityReduction": 0.5,
      "recoveryDays": 7,
      "recoveryIntensity": 2,
      "courseEquivalents": 0.31746031746031744,
      "laterReliefUSU": 22.171831695641217,
      "recoveryBurdenUSU": 2.2574955908289245,
      "selectedPainBalanceUSU": 19.914336104812293
    },
    "higher": {
      "label": "Higher",
      "costPerCourseUSD": 270,
      "averageIntensityReduction": 1,
      "recoveryDays": 3,
      "recoveryIntensity": 1,
      "courseEquivalents": 0.37037037037037035,
      "laterReliefUSU": 51.734273956496175,
      "recoveryBurdenUSU": 0.5643738977072311,
      "selectedPainBalanceUSU": 51.16990005878894
    },
    "no_relief": {
      "label": "No lasting relief",
      "costPerCourseUSD": 315,
      "averageIntensityReduction": 0,
      "recoveryDays": 7,
      "recoveryIntensity": 2,
      "courseEquivalents": 0.31746031746031744,
      "laterReliefUSU": 0.0,
      "recoveryBurdenUSU": 2.2574955908289245,
      "selectedPainBalanceUSU": -2.2574955908289245
    }
  },
  "unestimated": [
    "Non-pain vision benefits",
    "Relief before day 91 or after year one",
    "Full burden of complications and repeat surgery",
    "Psychological and family effects",
    "Deaths prevented",
    "Marginal donation allocation and displacement of other funding"
  ],
  "sources": [
    {
      "id": "T1",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5686479/",
      "accessedOn": "2026-10-17"
    },
    {
      "id": "T2",
      "url": "https://a.storyblok.com/f/274450/x/d97c5236fb/appendices-ictc-2025-gap-analysis.pdf",
      "accessedOn": "2026-10-17"
    },
    {
      "id": "T3",
      "url": "https://a.storyblok.com/f/274450/x/6d34d2c7e8/closing-the-gap-ictc-2025-gap-analysis-report_042125.pdf",
      "accessedOn": "2026-10-17"
    },
    {
      "id": "T4",
      "url": "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001136",
      "accessedOn": "2026-10-17"
    },
    {
      "id": "T5",
      "url": "https://www.sightsavers.org/contact-us/frequently-asked-questions/",
      "accessedOn": "2026-10-17"
    }
  ],
  "interpretation": "Assumption scenarios, not confidence intervals, measured cost-effectiveness or full uncertainty bounds. Effects may be zero or negative. Cannot rank against WSI gross-benefit donation scenarios."
}