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MichaelPlant comments on Cost-effectiveness analysis: drug liberalization holds promise as a mental health intervention - Effective Altruism Forum

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Comment author: Milan_Griffes 15 September 2017 02:15:37PM *  2 points [-]

I haven't engaged closely with your model, but here are some differences that immediately stand out:

  • Your analysis models the a change that impacts the entire UK, whereas ours models a change that impacts California.
  • Your model assumes that everyone in the UK who might benefit from treatment would seek treatment.
  • Your model assumes that everyone who receives treatment would benefit from treatment.
  • Your model doesn't include a replicability adjustment, to discount effect sizes due to the limited amount of evidence.
  • As far as I can tell, your model doesn't include costs of treatment, only costs of rescheduling.
Comment author: MichaelPlant 16 September 2017 01:21:38PM 1 point [-]

Hello Milan!

Your model assumes that everyone in the UK who might benefit from treatment would seek treatment. Your model assumes that everyone who receives treatment would benefit from treatment.

FWIW, in my model I don't assume either of those things. I assume an average counterfactual effect (counter to no rescheduling) of 0.1 HALYs for the 10m in the UK affected by depression or anxiety, not that they all get treatment or everyone benefits from the treatment (to be fair, I specify this in an edit of 14/08/2017 and you might have read it beforehand).

I don't mention replicability, but then I am assuming the rescheduling only brings a slight improvement (in the latter, more optimistic estimate I discuss whether this might be higher than 0.1 HALYs). I also mention the confusing possibility that treating some people with psychedelics might free up health care resources for other treatments.

I don't include costs of treatment, as I'm assuming this is an EA-funded campaign where our job, and what the money goes to, is changing the law and then allowing normal health care distribution to occur in the new scenario (i.e. in the US = insurer pays, in UK = govt pays).

Hence, looking at your model, I'm not sure why you include the costs of treatment, unless you think EA funders are going to be paying for those too. Even if you do think this, we should really want to have two seperate models, one for "cost of changing the law, assuming health practices then change aoccrdingly" and another for "cost effectiveness to EA funders to provide psychedelic therapy if it's available". As an aside, your model is really thorough, and I'm grateful to you for having put it together, good stuff!

This may also sound picky, but what we want to know (1) what is the most suitable model is for any give intervention, so if we're disagreeing with each other, we want to know why we're disagreeing, not just that we're disagreeing. Hence I was asking where and why you disagreed with my model.

You might reply your model is separate (campaign lobbying in UK vs ballot iniative and treatment funding in the US(?)) but, we also want to know (2) whether some new intervention is more cost-effective than all other current interventions an EA could fund (on one or more moral theory). If it's not more cost-effective then, all things considered, it would be bad to fund it. That's why I also asked if, and why, you think your drug policy reform strategy is more cost-effective than the one I proposed.

As it stands, we are perhaps comparing apples and oranges: you seem to have bundled treatment in with a policy change, and assumed this policy change will almost certainly occur depending on the polling numbers. I've just looked at policy change and estimated how much we could spend on it to change public/policy opinion and it still be more effective than AMF, assuming AMF is the current most cost-effective intervention. Hence we may need to get on the same page on this first.

Comment author: Milan_Griffes 16 September 2017 05:29:55PM *  0 points [-]

FWIW, in my model I don't assume either of those things. I assume an average counterfactual effect (counter to no rescheduling) of 0.1 HALYs for the 10m in the UK affected by depression or anxiety, not that they all get treatment or everyone benefits from the treatment (to be fair, I specify this in an edit of 14/08/2017 and you might have read it beforehand).

I see, thanks for clarifying. I think an average counterfactual effect of 0.1 HALY is very large (using the assumptions from our model, it implies a 1.20 HALY per treatment improvement in people who try and respond to the treatment: 0.1 average HALY / (0.57 people who seek treatment * 0.44 treatment-seekers who would try psilocybin treatment * 0.33 treatment-takers who respond to treatment).

With a DALY weight for major depression of 0.65, this implies that 1 psilocybin treatment alleviates major depression for 2 years, which is very optimistic. How are you deriving the 0.1 figure?

I don't mention replicability, but then I am assuming the rescheduling only brings a slight improvement

As above, I don't think the assumed improvement is slight. We should definitely include a replicability adjustment as these effects are demonstrated in small-N pilot studies.

I'm not sure why you include the costs of treatment, unless you think EA funders are going to be paying for those too

From my comment further up the thread:

"You could think of this analysis as trying to model whether psychedelic treatments for mental health conditions would be cost-effective if they were available today. For example, consider a promising intervention that would entirely cure someone's depression for a year, but costs $10,000,000 per treatment. We probably wouldn't want to run a ballot initiative to increase access to such a intervention, as it wouldn't be cost-effective even if it were easily accessible."

My understanding is that most public health cost-effectiveness modeling includes all costs of treatment, regardless of who's paying.

That's why I also asked if, and why, you think your drug policy reform strategy is more cost-effective than the one I proposed.

I haven't yet thought enough about what strategy makes the most sense. Our model is designed to be largely strategy-agnostic, as most of the costs are costs-of-treatment.

assumed this policy change will almost certainly occur depending on the polling numbers.

Sort of. I think a lot of the tractability question here hinges on what the polling looks like, which is what we're planning to look into next.

Comment author: MichaelPlant 24 September 2017 04:54:33PM 0 points [-]

I think we're talking past each other on exactly which counterfactuals we have in mind.

There seem to be a couple of bits:

Counterfactual A is: how much better magic mushrooms (MM) is than conventional treatment for people who undergo conventional treatment. This should be multiplied by the number of years before the rescheduling would otherwise have occured.

An additional counterfactual B is: assuming counterfactual A happens and is cheaper than current treatment, that should free up resources for treating the mentally ill who didn't get MM treatment. Should also use the same timescale as A.

I'm now lost on exactly what you're modelling. My model lumps A and B together and assumed a 0.1 HALY increase average across those with depression or anxiety in the UK.

Moving on

My understanding is that most public health cost-effectiveness modeling includes all costs of treatment, regardless of who's paying.

I think this is the wrong way to think about it from an EA perspective. Imagine I'm a rich funder. I will pay for the ballot iniative, but I won't be pay for the health treatments. hence when i do my cost-effectiveness analysis for the ballot, my cost is the ballot expenditure only, the benefit is the counterfactual happiness increase that rules from the new treatments occurring, presuming normal health stuff happens, i.e. doctors upgrade to the new treatments.

As the funder who wants to do the most good, I'm comparing the cost effectivess of this ballot to other things I could fund, like bednets. I'm not funding the treatments themselves, so that's misleading. If I were a government, maybe I'd think about it the way you propose, but then governments dont fund ballot initiative, so that would also be misleading.

It could be the case that, one psychedlics are used in treatment, I could then, as a rich funder, think about paying for those vs paying for bednets. As I said before, that is also an important question. hence we want to split these apart for greater accuracy.