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Living with COVID 19: Balancing costs against benefits in the face of the virus
  • David Miles,
  • Mike Stedman,
  • Adrian Heald
David Miles
Imperial College London
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Mike Stedman
Res Consortium
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Adrian Heald
Salford Royal Hospitals NHS Trust
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Abstract

The COVID-19 pandemic has transformed lives across the world. In the UK there has been a public health driven policy of population ‘lockdown’ that had enormous personal and economic impact. We compare UK response/outcomes including excess deaths with European countries with similar levels of income/healthcare resources. We calibrate estimates of the economic costs as different %loss in GDP against possible benefits of avoiding life years lost, for different scenarios where local COVID-19 mortality/comorbidity rates were used to calculate the loss in life expectancy. We apply quality-adjusted life years (QALY) value of £30,000 (maximum under NICE guidelines). The implications for future lockdown easing policy in the UK are also evaluated. The spread of cases across European countries was extremely rapid. There was significant variation both in severity and timing of both implementation and subsequent reductions in social restrictions. There was less variation in the trajectory of mortality rates and excess deaths, which have fallen across all countries during May/June 2020. The average age at death and life expectancy loss for non-COVID-19 was 79.1 and 11.4years respectively while COVID-19 were 80.4 and 10.1years; including for life-shortening comorbidities and quality of life reduced this to 5QALY for each COVID-19 death. The lowest estimate for lockdown costs incurred was 50% higher than highest benefits from avoiding the worst mortality case scenario at full life expectancy tariff and in more realistic estimation they were over 50 times higher. Application to potential future scenarios showed in the best case a QALY value of £220k (7xNICE guideline) and in the worst-case £3.7m (125xNICE guideline) was needed to justify the continuation of the lockdown. The evidence suggests that the costs of continuing severe restrictions in the UK are so great relative to likely benefits in numbers of lives saved so that a substantial easing in restrictions is now warranted.

Peer review status:ACCEPTED

16 Jun 2020Submitted to International Journal of Clinical Practice
16 Jun 2020Submission Checks Completed
16 Jun 2020Assigned to Editor
18 Jun 2020Reviewer(s) Assigned
02 Jul 2020Review(s) Completed, Editorial Evaluation Pending
13 Jul 20201st Revision Received
15 Jul 2020Assigned to Editor
15 Jul 2020Submission Checks Completed
15 Jul 2020Reviewer(s) Assigned
19 Jul 2020Review(s) Completed, Editorial Evaluation Pending
04 Aug 20202nd Revision Received
05 Aug 2020Reviewer(s) Assigned
05 Aug 2020Submission Checks Completed
05 Aug 2020Assigned to Editor
06 Aug 2020Review(s) Completed, Editorial Evaluation Pending
08 Aug 20203rd Revision Received
08 Aug 2020Submission Checks Completed
08 Aug 2020Assigned to Editor
09 Aug 2020Review(s) Completed, Editorial Evaluation Pending
10 Aug 2020Editorial Decision: Accept