Stay at home, protect the National Health Service, save lives: A cost benefit analysis of the lockdown in the United Kingdom
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Published version
Author(s)
Miles, David
Type
Journal Article
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.
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.
Date Issued
2021-03
Date Acceptance
2020-08-10
Citation
International Journal of Clinical Practice, 2021, 75 (3), pp.1-14
ISSN
1368-5031
Publisher
Wiley
Start Page
1
End Page
14
Journal / Book Title
International Journal of Clinical Practice
Volume
75
Issue
3
Copyright Statement
© 2020 The Authors. International Journal of Clinical Practice published by John Wiley & Sons Ltd
This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Identifier
https://onlinelibrary.wiley.com/doi/10.1111/ijcp.13674
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
Pharmacology & Pharmacy
General & Internal Medicine
COVID-19
economics
strategy
unlock
UTILITY VALUES
COVID-19
economics
strategy
unlock
General Clinical Medicine
1103 Clinical Sciences
1117 Public Health and Health Services
1701 Psychology
Publication Status
Published
Date Publish Online
2020-08-13