PMI-CPMAI expects the project manager to determine ROI by calculating expected benefits, estimating total cost of ownership, developing a financially justified business case, and creating cost-benefit analysis to support stakeholder decisions. In this scenario, the project is only 60% complete, so the full benefits (reduced wait times, throughput gains, staffing efficiency) may not yet be fully realized or measurable. Under PMI’s ROI determination intent—supporting business case justification while outcomes are still unfolding—an effective method is to project future benefits and compare them to investment, which is what an NPV model enables. NPV is useful when benefits accrue over time and when decision makers need a defensible view of value before full delivery, because it discounts future benefits and costs into today’s terms for comparison. Option B is attractive but assumes benefits are already fully observable and monetized; in many public-sector healthcare settings, translating wait-time reductions into verified cash savings can be nontrivial midstream. Options C and D are not explicitly called out in PMI-CPMAI’s ROI determination tasks, while the outline explicitly emphasizes financial justification and cost-benefit framing—well supported by NPV.