Abstract
I critique a recent analysis (Miles, Stedman & Heald, 2020) of COVID-19 lockdown costs and benefits, focussing on the United Kingdom (UK). Miles et al. (2020) argue that the March-June UK lockdown was more costly than the benefit of lives saved, evaluated using the NICE threshold of £30000 for a quality-adjusted life year (QALY) and that the costs of a lockdown for 13 weeks from mid-June would be vastly greater than any plausible estimate of the benefits, even if easing produced a second infection wave causing over 7000 deaths weekly by mid-September. I note here two key problems that significantly affect their estimates and cast doubt on their conclusions. Firstly, their calculations arbitrarily cut off after 13 weeks, without costing the epidemic end state. That is, they assume indifference between mid-September states of 13 or 7500 weekly deaths and corresponding infection rates. This seems indefensible unless one assumes that (a) there is little chance of any effective vaccine or improved medical or social interventions for the foreseeable future, (b) notwithstanding temporary lockdowns, COVID-19 will very likely propagate until herd immunity. Even under these assumptions it is very questionable. Secondly, they ignore the costs of serious illness, possible long-term lowering of life quality and expectancy for survivors. These are uncertain, but plausibly at least as large as the costs in deaths.In summary, policy on tackling COVID-19 cannot be rationally made without estimating probabilities of future medical interventions and long-term illness costs. More work on modelling these uncertainties is urgently needed.
Highlights
Many countries, including the United Kingdom (UK), have imposed temporary lockdowns in response to the COVID-19 pandemic
Without estimates and some framework for comparing human lives and well-being with monetary costs, policy would be made in a vacuum. The approach they take is to consider the costs of COVID-19 deaths by estimating the quality-adjusted life years (QALYs) lost
My focus is on two narrower questions: does it make sense to follow Miles et al in considering costs and benefits over a fixed period (13 weeks), without taking the future consequences into account? And is it justifiable to ignore the losses arising from COVID-19 illness that does not result in death? I argue that the answer to both questions is no, and that Miles et al.’s analyses are flawed and their conclusions unreliable
Summary
Many countries, including the UK, have imposed temporary lockdowns in response to the COVID-19 pandemic. They may have directly cost lives, in the sense that more people may have died or will die from some non-COVID causes than would otherwise have been the case They have been extremely costly economically, and these costs translate into effective lives lost in various ways: for example, unemployment adversely affects quality of life and life expectancy, while lower government revenues and lower citizens’ incomes mean fewer resources for public and private health care. The approach they take is to consider the costs of COVID-19 deaths (or the benefits of lives saved by interventions) by estimating the quality-adjusted life years (QALYs) lost (or gained) They use one of the National Institute for Clinical Excellence (NICE) guideline (Paulden, 2017) figures, according to which a treatment expected to increase life expectancy by one QALY should cost no more than £30000. My focus is on two narrower questions: does it make sense to follow Miles et al in considering costs and benefits over a fixed period (13 weeks), without taking the future consequences into account? And is it justifiable to ignore the losses arising from COVID-19 illness that does not result in death? I argue that the answer to both questions is no, and that Miles et al.’s analyses are flawed and their conclusions unreliable
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