Section 5 – Bringing costs and benefits together:
Bringing together costs and benefits is necessary if good policy decision are to be made. There is no simple way to do this that is clearly ethically justifiable, empirically reliable and widely accepted. But to make no assessment is just to make policy in a vacuum. One approach is to focus on quality-adjusted life years (QALYs) that may have been saved as a result of restrictions that have been in place in the UK up to early June and to convert that to a metric that can be compared with estimates of the cost of the restrictions. That is the strategy we follow. We then go on to make estimates of costs and benefits of alternative ways forward with restrictions eased to different extents.
We make use of the guidelines established in the UK by the National Institute for Health and Care Excellence (NICE) for the use of resources in the UK health system (see NICE (2013) (20). These are guidelines applied to resource decisions that have a direct impact on lives saved. It is hard to see how you could run a public health care system without such rules. The guidelines in the UK set out by NICE are that treatments that are expected to increase life expectancy for a patient by one year (in quality of life adjusted years, QALYs) should cost no more than £30,000. We apply that figure to possible total numbers of QALYs saved by restrictions to estimate their benefit.
To implement this we need to assess how many likely extra years of good life might be enjoyed by the people who would have died but for a lockdown. We assume that the age and health of those who would have died are similar to that of those who have died with the virus.
The Office for National Statistics (ONS) has been publishing each week the number of deaths where COVID-19 has been recorded as a possible cause by quinary age and gender. In total up to the week ending 22 May, this was 43,694 in England and Wales. (This total is 21% below the excess all causes deaths figure of 55,504 up to w/e 24th May (Week 21) calculated by comparing the actual recorded number in 2020 to the average deaths over previous 3 years in the same period).
By applying the average life expectancy (21) to the actual recorded COVID-19 deaths by age and gender a total life expectancy years lost can be calculated. Table 1 shows the calculation. Average life expectancy loss comes out at 10.1 years per COVID-19 death. (The average life expectancy years lost for a non COVID-19 death is higher at 11.4 confirming that the age for COVID mortality is older than normal mortality). The median COVID-19 age at death is around 80 and the average life years lost for the older 50% is 5 years and the for younger 50% is 15 years.