In this shallow cause exploration, we explore the relationship between pain and subjective wellbeing; assess the severity and scale of chronic pain in terms of life satisfaction; and offer some novel back-of-the-envelope calculations for the cost-effectiveness of several interventions to treat pain.
In this report, we summarise the debate about the efficacy of deworming, present the first analysis of deworming in terms of subjective wellbeing, and compare the cost-effectiveness of deworming to StrongMinds (our current top recommended charity).
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.
We raise twelve critiques of GiveWell’s cost-effectiveness analyses. Ten apply to specific inputs for malaria prevention, cash transfers, and deworming. Two are relevant for more than one intervention.
We propose the wellbeing-adjusted life year (WELLBY), the wellbeing equivalent of the DALY or QALY, as the obvious framework to do cost-effectiveness analyses of non-health, non-pecuniary benefits.
We make 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.