“Stay at Home, Protect the National Health Service, Save Lives”: A cost benefit analysis of the lockdown in the United Kingdom

Abstract

Introduction The COVID‐19 pandemic has transformed lives across the world. In the UK, a public health driven policy of population ‘lockdown’ has had enormous personal and economic impact. Methods We compare UK response and outcomes with European countries of similar income and healthcare resources. We calibrate estimates of the economic costs as different % loss in Gross Domestic Product (GDP) against possible benefits of avoiding life years lost, for different scenarios where current COVID‐19 mortality and comorbidity rates were used to calculate the loss in life expectancy and adjusted for their levels of poor health and quality of life. We then apply a quality‐adjusted life years (QALY) value of £30,000 (maximum under national guidelines). Results There was a rapid spread of cases and 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 11.4 years respectively while COVID‐19 were 80.4 and 10.1 years; including adjustments for life‐shortening comorbidities and quality of life plausibly reduces this to around 5 QALY lost for each COVID‐19 death. The lowest estimate for lockdown costs incurred was 40% higher than highest benefits from avoiding the worst mortality case scenario at full life expectancy tariff and in more realistic estimations they were over 5 times higher. 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 lockdown. Conclusion This suggests that the costs of continuing severe restrictions are so great relative to likely benefits in lives saved that a rapid easing in restrictions is now warranted.

Considerations for diagnostic COVID-19 tests

“…However, regional success stories involving, for instance, local test or tool production were reported from South Africa and Rwanda 95,96 . Although some initial cost estimates of the COVID19 disruption in the health care industry have been published [97][98][99] , they are likely to be too preliminary at this point in terms of their accuracy. Estimating the costs of such a complex industrial pivoting is difficult as it affects at a minimum the costs of developing and generating new products, the transformation of the pro duction lines and any potential losses from established products not manufactured during the given period 1 .…”

National health system cuts and triage decisions during the COVID-19 pandemic in Italy and Spain: ethical implications

“…30 For those who do not accept the logic of utilitarianism, the expression ‘social utility’ certainly cannot be considered interchangeable with the expression ‘common good’. 32 …”

Exploratory comparison of Healthcare costs and benefits of the UK’s Covid-19 response with four European countries

“…The economic case for stringent social distancing measures has been questioned due to their impact on the economy and livelihoods. 5 , 6 A cost-benefit analysis of government responses to Covid-19 requires an infectious disease model to project the counterfactual of what would have happened in the absence of government intervention. The first wave of Covid-19 in Europe was largely complete by July 2020; complete data on observed outcomes are therefore available for comparison with modelled outcomes, and it is thus possible to compare the costs and benefits of Government responses to this first wave.…”

“… 10 Miles (2020) compared predictions of outcomes under no mitigation to observed outcomes up to June 2020, using an informal estimate of 5 QALYs lost per death. 6 They compared the reductions in actual GDP growth forecasts to costs and QALYs saved by government response. They found that continuing the lockdown was only cost-effective at a willingness-to-pay per QALY between £220 000 and £3.7 million.…”