Thank you so much for doing this and writing about it. Iāve been thinking about this post for weeks.
It feels extremely weird to quibble about numbers in situations like this.[1] As you write, a personās life and health are worth so much more than anything else we could buy with a few thousand dollars, we should be willing to give a thousand suns. The difference between these two is always a reminder of how unfair things are.
That said, keeping in mind that Iām not at all an expert in cost-effectiveness estimates, here are some considerations for cost-effectiveness that might be worth considering.
I think the ābarā shouldnāt be the cost per life saved of the average GiveWell intervention ($5.5k) but the marginal cost of ~$7.5k. And of course we should keep in mind that these numbers are extremely rough with huge uncertainties, so I donāt think any decision should hinge on the difference between $7.5k and $5k.
On the other hand, GiveWellās interventions have many other positive effects. For example, ~35% of the value of AMFās program is estimated to come from non-life-saving development benefits, which would compensate for the higher bar.
Considering both the āchance of help without interventionā and the ācost for the hospitalā seems to be excessively conservative. I would imagine that the help from someone else would still incur some cost for the hospital and the people helping. So, I would only consider one of them. This seems especially relevant in the malnutrition case.
I also wonder about the hospitalās opportunity cost. I might be showing my ignorance here, but would the burns unit in your first example and the cardiopulmonary bypass machine in your last example be doing non-life-saving work without this intervention? If thatās the case, I think you could (very) heavily discount the economic cost for them. Otherwise, the economic cost could be modelled as similar to a donation to the hospital.
Lastly, the estimates for the relative quality of life in case of success might sadly be too high. Possibly ignorantly, I would expect these individuals to live in a worse environment with fewer resources and a worse support network compared to the population average; they might have a lower life expectancy and more future risks.
That said, I tried to do a BOTEC and the results were in the same ballpark (but highly sensitive to e.g. the chance of survival without help).
Again, thank you so much for all the work youāre doing.
Iāve been sitting on this comment since I read this post, since it feels so insensitive to nitpick numbers in response to such a personal and ārealā post. I canāt even imagine what it must feel like to act on these numbers.
Amazing response and thanks so much for looking more closely at the numbers, I was hoping someone would!. Absolutely love that you made your own spreadsheet, great to get a sanity check at least. To respond individually to your fantastic points.
I hadnāt considered the 7.5k bar I agree that may make more sense. Iām not sure though that if this was going to be done at any scale, āhigh uncertaintiesā should lead to a fuzzier barāI struggle to see how that works practically. Iām not sure how any cost-effectiveness seeking intervention works without a fairly solid theoretical cut-off? a As a side note as well, as cost-effective interventions go, helping individuals would perhaps be at the lower end of uncertainty
This is a good point about the 35% of non life-saving benefits for AMF. Obviously here there are also many non life-saving events with similar pathways to AMF, but Iām not sure how that compares
Thanks for this comment on excessive conservatism, I think I agree nice one!
Yes how to include other non-donation costs is a real head scratcher and I struggle to get my head around.. For burns and Heart surgery, much of the work the hospitals are doing is indeed life savingāmore so for the heart surgery than the burns. Even the non-life saving burns work has potentially huge impacts on the patientsā lives.
This is an excellent point, I think I was probably being overly optimistic here and would downgrade these in future.
Thanks so much again for your work as well. As much as thinking about helping individual people might speak to us and hit us emotionally, my guess would be that your work developing software at Giving What We Can may well be a more cost-effective way of helping people.
Thank you so much for doing this and writing about it. Iāve been thinking about this post for weeks.
It feels extremely weird to quibble about numbers in situations like this.[1] As you write, a personās life and health are worth so much more than anything else we could buy with a few thousand dollars, we should be willing to give a thousand suns. The difference between these two is always a reminder of how unfair things are.
That said, keeping in mind that Iām not at all an expert in cost-effectiveness estimates, here are some considerations for cost-effectiveness that might be worth considering.
I think the ābarā shouldnāt be the cost per life saved of the average GiveWell intervention ($5.5k) but the marginal cost of ~$7.5k. And of course we should keep in mind that these numbers are extremely rough with huge uncertainties, so I donāt think any decision should hinge on the difference between $7.5k and $5k.
On the other hand, GiveWellās interventions have many other positive effects. For example, ~35% of the value of AMFās program is estimated to come from non-life-saving development benefits, which would compensate for the higher bar.
Considering both the āchance of help without interventionā and the ācost for the hospitalā seems to be excessively conservative. I would imagine that the help from someone else would still incur some cost for the hospital and the people helping. So, I would only consider one of them. This seems especially relevant in the malnutrition case.
I also wonder about the hospitalās opportunity cost. I might be showing my ignorance here, but would the burns unit in your first example and the cardiopulmonary bypass machine in your last example be doing non-life-saving work without this intervention? If thatās the case, I think you could (very) heavily discount the economic cost for them. Otherwise, the economic cost could be modelled as similar to a donation to the hospital.
Lastly, the estimates for the relative quality of life in case of success might sadly be too high. Possibly ignorantly, I would expect these individuals to live in a worse environment with fewer resources and a worse support network compared to the population average; they might have a lower life expectancy and more future risks.
That said, I tried to do a BOTEC and the results were in the same ballpark (but highly sensitive to e.g. the chance of survival without help).
Again, thank you so much for all the work youāre doing.
Iāve been sitting on this comment since I read this post, since it feels so insensitive to nitpick numbers in response to such a personal and ārealā post. I canāt even imagine what it must feel like to act on these numbers.
Amazing response and thanks so much for looking more closely at the numbers, I was hoping someone would!. Absolutely love that you made your own spreadsheet, great to get a sanity check at least. To respond individually to your fantastic points.
I hadnāt considered the 7.5k bar I agree that may make more sense. Iām not sure though that if this was going to be done at any scale, āhigh uncertaintiesā should lead to a fuzzier barāI struggle to see how that works practically. Iām not sure how any cost-effectiveness seeking intervention works without a fairly solid theoretical cut-off? a As a side note as well, as cost-effective interventions go, helping individuals would perhaps be at the lower end of uncertainty
This is a good point about the 35% of non life-saving benefits for AMF. Obviously here there are also many non life-saving events with similar pathways to AMF, but Iām not sure how that compares
Thanks for this comment on excessive conservatism, I think I agree nice one!
Yes how to include other non-donation costs is a real head scratcher and I struggle to get my head around.. For burns and Heart surgery, much of the work the hospitals are doing is indeed life savingāmore so for the heart surgery than the burns. Even the non-life saving burns work has potentially huge impacts on the patientsā lives.
This is an excellent point, I think I was probably being overly optimistic here and would downgrade these in future.
Thanks so much again for your work as well. As much as thinking about helping individual people might speak to us and hit us emotionally, my guess would be that your work developing software at Giving What We Can may well be a more cost-effective way of helping people.