How should we compare the value of extending lives to improving lives? Doing so requires us to make various philosophical assumptions, either implicitly or explicitly. But these choices are rarely acknowledged or discussed by decision-makers, all of them are controversial, and they have significant implications for how resources should be distributed.
Joel McGuire
We propose the wellbeing-adjusted life year (WELLBY), the SWB equivalent of the DALY or QALY, as the obvious framework to do cost-effectiveness analyses of non-health, non-pecuniary benefits. As our previous work has shown, using WELLBYs can change funding priorities by giving more weight to improving mental health, compared to DALYs or income measures.
We provide four recommendations to improve GiveWell’s cost-effectiveness analyses: (1) publicly explain and defend their assumptions about the effect of deworming over time; (2) explain their cost-effectiveness analyses in writing; (3) illustrate the sensitivity of their results to key parameters; (4) make it clear when an estimate is subjective or evidence-based.
We update our previous analysis to incorporate the household spillover effects for cash transfers and psychotherapy. We estimate that psychotherapy is 9 times (95% CI: 2, 100) more cost-effective than cash transfers. The charity StrongMinds is estimated to be 9 times (95% CI: 1, 90) more cost-effective than the charity GiveDirectly.
Drawing on evidence from over 80 studies and over 140,000 participants, we compare the cost-effectiveness of cash transfers and psychotherapy by estimating their effect on the recipient's subjective wellbeing and affective mental health.
This report explains how we determined the cost-effectiveness of cash transfers using subjective wellbeing and affective mental health.
This report explains how we determined the cost-effectiveness of group or task-shifted psychotherapy in low- and middle-income countries using subjective wellbeing and affective mental health.
This report explains how we determined the cost-effectiveness of StrongMinds using subjective wellbeing and affective mental health.
We know that cash transfers reduce poverty, improve health and enhance education but what impact do they have on how people feel and think about their lives? We find that cash transfers have a small, positive effect on subjective wellbeing, one that lasts for several years.
We show how Wellbeing-Adjusted Life Years (WELLBYs) can be used to estimate the value of different outcomes. We then estimate the values of two key inputs in GiveWell’s analysis: doubling consumption for one person for one year and averting the death of a child under 5 years old.