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# Why Is It So Expensive to Save Lives?

*Note added July 2022: The content of this page is based on impact estimates we produced in 2021. Some of the figures listed on this page may not exactly match those in the updated impact estimates we calculated in 2022. While some details about the specific example grant described below may no longer be completely accurate, the general ideas presented on this page remain true.*

*Published: December 2021; Last updated: September 2022*

Our recommended charities produce outcomes that help save lives. These charities are the most cost-effective programs we’ve found at saving lives.

Because the initial outputs of these charities are so inexpensive (for example, it costs about $5 to purchase and deliver an insecticide-treated net), many people are surprised at how expensive it is to save a life—about $4,500 on average for funding we directed in 2020.1

We hope that this 2020 example helps illustrate the discrepancy in cost between the initial outputs and the cost to save a life. This example does not reflect what we estimate this program's cost to save a life will be in the future. We generally expect the cost to save a life to increase over time.

### The cost to save a life for one grant

Below we’ll explain our 2020 estimate for how $4,500 could save a life in Guinea by funding a net distribution through the Against Malaria Foundation. These numbers are based on a $7.2 million grant to AMF we funded in 2020. We estimate this grant will provide 1.6 million nets and save about 1,700 lives. We chose Guinea for this example because the cost-effectiveness of nets distributed there was close to the average cost-effectiveness of nets AMF distributed with grants from GiveWell’s Top Charities Fund (we updated the name of this fund in September 2022, more information here) and grants from Open Philanthropy in 2020.2

### What $4,500 accomplished with AMF in Guinea3

Metric | Explanation | |
---|---|---|

Step One: |
1,001 nets delivered |
The cost of purchasing and delivering each net is about $4.50,4 so $4,500 in donations can purchase about 1,001 nets.5 |

Step Two: |
795 nets are in use |
Evidence suggests that not all purchased nets are actually put to use. Based on this evidence, we estimate that about 79% of delivered nets are used in practice. So about 795 are actually in use as a result of this donation.6 |

Step Three: |
1,431 people are protected by nets |
Nets are often used to cover multiple people. On average, each net covers 1.8 people, implying that 795 nets in use protect 1,431 people.7 |

Step Four: |
12 of those people are expected to die every year of any cause |
In order to estimate how many lives these nets might save, we first need to know how many people in this population would have died without the protection of the nets. The mortality rates and population demographics in Guinea suggest that about twelve out of 1,431 people would have died per year of any cause (including malaria).8 |

Step Five: |
1.3 lives are saved by the net distribution |
Based on the results of academic studies on the effectiveness of insecticide-treated nets, we estimate that this net distribution will reduce the number of deaths each year within this population from 12 to about 11.4. We multiply 0.6 deaths averted per year by 2.1, the average number of years nets provide coverage. In our initial estimate, this donation will avert 1.3 deaths.9 |

Step Six: |
1.0 life is saved by this donation once we account for its effect on other funders |
Donations can affect the behavior of other funders. In this case, we expect that this $4,500 donation will cause other funders to shift some amount of their giving from net distributions to other programs. We account for that to give a true estimate of impact. Once we adjust for the impact of that reduced funding, we estimate that this donation will save one life.10 You can read more about how we account for the behavior of other funders here. |

### Additional benefits

That $4,500 donation may have also accomplished some additional outcomes that are not explicitly incorporated into the above cost-effectiveness outline. These benefits include:

- Averting non-fatal malaria infections. Non-fatal infections can still cause a significant amount of suffering.
- Some potential economic effects. There’s some evidence that suggests that averting a case of malaria in children will allow those children to earn more money later in life.

We hope that this was helpful to understand, at a very high level, some of the concepts that we incorporate and the judgments we make in our research. If you have any feedback for us, please fill out this form.

## Sources

Document | Source |
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GiveWell, GiveWell directed grants with impact information (2020 onward) | Source |

GiveWell, Simplified Guinea cost analysis, 2021 | Source |

- 1For a more detailed and updated version of our analysis, see our full cost-effectiveness models.
- 2The overall weighted average cost per life saved from Top Charities Fund and Open Philanthropy grants to AMF in 2020 was $4,500. GiveWell, GiveWell directed grants with impact information (2020 onward)
- 3The calculations we describe in the right-hand column are presented with rounded figures. However, the figures we share in the left-hand column are based on calculations using the underlying, non-rounded figures, leading to minor discrepancies at times. For example, in the second item, both 79% and 1,001 nets are rounded figures. The left-hand figure of 795 nets in use is based on the underlying, non-rounded figures.
- 4GiveWell, Simplified Guinea cost analysis, 2021.
- 5GiveWell, Simplified Guinea cost analysis, 2021.
- 6GiveWell, Simplified Guinea cost analysis, 2021.
- 7GiveWell, Simplified Guinea cost analysis, 2021.
- 8GiveWell, Simplified Guinea cost analysis, 2021.
- 9GiveWell, Simplified Guinea cost analysis, 2021.
- 10GiveWell, Simplified Guinea cost analysis, 2021.