Reconciling cost-effectiveness with the rule of rescue: the institutional division of moral labour

Orr, Shepley; Wolff, Jonathan

doi:10.1007/s11238-014-9434-3

Cited by 31 publications

(15 citation statements)

References 17 publications

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“…34 , 35 There will undoubtedly be substantial debate about what the relevant WTP threshold should be and even whether the pandemic constitutes a special case in which considerations of cost-effectiveness are less relevant (eg, Rule of Rescue). 36 …”

Section: Discussionmentioning

confidence: 99%

Costing the COVID-19 Pandemic: An Exploratory Economic Evaluation of Hypothetical Suppression Policy in the United Kingdom

Zala¹,

Mosweu

Critchlow

et al. 2020

Value in Health

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Objective This study aims to cost and calculate the relative cost-effectiveness of the hypothetical suppression policies found in the Imperial College COVID-19 Response Team model. Methods Key population-level disease projections in deaths, intensive care unit bed days, and non–intensive care unit bed days were taken from the Imperial College COVID-19 Response Team report of March 2020, which influenced the decision to introduce suppression policies in the United Kingdom. National income loss estimates were from a study that estimated the impact of a hypothetical pandemic on the UK economy, with sensitivity analyses based on projections that are more recent. Individual quality-adjusted life-year (QALY) loss and costed resource use inputs were taken from published sources. Results Imperial model projected suppression polices compared to an unmitigated pandemic, even with the most pessimistic national income loss scenarios under suppression (10%), give incremental cost-effectiveness ratios below £50 000 per QALY. Assuming a maximum reduction in national income of 7.75%, incremental cost-effectiveness ratios for Imperial model projected suppression versus mitigation are below 60 000 per QALY. Conclusions Results are uncertain and conditional on the accuracy of the Imperial model projections; they are also sensitive to estimates of national income loss. Nevertheless, it would be difficult to claim that the hypothetical Imperial model–projected suppression policies are obviously cost-ineffective relative to the alternatives available. Despite evolving differences between government policy and Imperial model–projected suppression policy, it is hoped this article will provide some early insight into the trade-offs that are involved.

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Section: Discussionmentioning

confidence: 99%

Costing the COVID-19 Pandemic: An Exploratory Economic Evaluation of Hypothetical Suppression Policy in the United Kingdom

Zala¹,

Mosweu

Critchlow

et al. 2020

Value in Health

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show abstract

“…In this kind of framework what needs to be balanced are the economic costs associated to social distancing and the imputed costs of losses of life and health (including its implications for production broadly defined). This is a standard, albeit seemingly ‘heartless’, feature of how most public national health systems operate when it comes to decisions pertaining to treatment availability (Orr and Wolff, 2015).…”

Section: Ethical and Distributive Aspectsmentioning

confidence: 99%

COVID‐19: A Make or Break Moment for Global Policy Making

Maffettone

Oldani

2020

Global Policy

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The COVID-19 pandemic poses an unprecedented set of challenges to governments, policy makers and citizens; lockdowns and social distancing measures generate significant economic losses, fuel public expenditures and deficits and will no doubt significantly boost public debts. The burden of such measures is also likely to be disproportionately felt by the worse-off members of society and will weigh heavily on future generations. This is both unfair and runs the risk of politically destabilizing the recovery process. To avoid these outcomes unconventional policy measure such as taxes on private wealth and digital economic activities, but also public debt monetization, should be considered. From a political perspective, governments should realize that policy coordination is the only successful exit strategy following a systemic economic shock. While the EU is moving faster than we are accustomed to, it still seems unable to respond quickly enough given the nature of the circumstances. In this picture, the G-20, provided it acts quickly over the coming months, could emerge as the sole global policy forum left on the playing field that can avoid that national interests will prevail eventually producing collectively sub-optimal results in the long-run.

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“…What normatively justifies its existence and makes it attractive is precisely its concern with issues of fairness. 9 …”

Section: What Is the Purpose Of Cost-effectiveness Analysis And Is Itmentioning

confidence: 99%

How can we decide a fair allocation of healthcare resources during a pandemic?

Roadevin

Hill

2021

J Med Ethics

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Whenever the government makes medical resource allocation choices, there will be opportunity costs associated with those choices: some patients will have treatment and live longer, while a different group of patients will die prematurely. Because of this, we have to make sure that the benefits we get from investing in treatment A are large enough to justify the benefits forgone from not investing in the next best alternative, treatment B. There has been an increase in spending and reallocation of resources during the COVID-19 pandemic that may have been warranted given the urgency of the situation. However, these actions do not bypass the opportunity cost principle although they can appear to in the short term, since spending increases cannot continue indefinitely and there are patient groups who lose out when resources are redirected to pandemic services. Therefore, policy-makers must consider who bears the cost of the displaced healthcare resources. Failure to do so runs a risk of reducing overall population health while disproportionally worsening health in socially disadvantaged groups. We give the example of ethnic minorities in England who already had the worst health and, due to structural injustices, were hardest hit by the pandemic and may stand to lose the most when services are reallocated to meet the resource demands of the crisis. How can we prevent this form of health inequity? Our proposal is forward-looking: we suggest that the government should invest our resources wisely while taking issues of equity into account–that is, introduce cost–equity analysis.

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Reconciling cost-effectiveness with the rule of rescue: the institutional division of moral labour

Cited by 31 publications

References 17 publications

Costing the COVID-19 Pandemic: An Exploratory Economic Evaluation of Hypothetical Suppression Policy in the United Kingdom

Costing the COVID-19 Pandemic: An Exploratory Economic Evaluation of Hypothetical Suppression Policy in the United Kingdom

COVID‐19: A Make or Break Moment for Global Policy Making

How can we decide a fair allocation of healthcare resources during a pandemic?

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