With questions being voiced about the cost effectiveness of the measures being used to tackle covid-19, an article published by The BMJ today asks are the costs worth the benefits?
This may seem an outrageous question, writes author John Appleby, Chief Economist at the Nuffield Trust. Surely, we must do all we can to minimise mortality and morbidity from covid-19?
But he points out that the cost-benefit question is one that all health systems face on every day.
For instance, is drug X better than drug Y? Should stroke services be centralised? How long should treatment continue for a particular patient? Or more specifically, which patients with covid-19 should be prioritised for ventilation?
The National Institute for Health and Care Excellence (NICE) was set up in an attempt to make these decisions more transparent and consistent.
But, says Appleby, it can be hard to reconcile the outcome of a cost effectiveness analysis that suggests an intervention is not worth doing when it comes to certain situations, such as rescuing people in emergency situations.
So does cost effectiveness even have a role when it comes to the covid-19 emergency?
There is still considerable uncertainty about the impact of the pandemic, he says. For example, a proportion of people who have so far died with covid-19 would have died this year from other causes.
He acknowledges that there are, and will be, undoubted benefits from the interventions the UK has been pursuing to mitigate the impact of covid-19, but says current figures represent best estimates so far and will change as the pandemic evolves.
At this point the ugly question that could be asked is whether the value of the benefits (deaths averted or quality of life years (QALYs) saved, say) is more or less than the (opportunity) costs of the interventions, he writes.
Opportunity costs will include “excess” non-covid deaths because of reduced use of health services and delays in treatment of other illnesses arising from the NHS prioritising resources on covid-19.
Of course, he says, the cost-benefit balance could change depending on the success of all the interventions being tried, including possibly millions of extra tests, increased personal protective equipment, ventilators, etc—and, not least, the discovery of an effective vaccine.
“But for now, the nature of the covid-19 pandemic suggests we shouldn’t base any decisions about doing something versus doing nothing on the results of inevitably imperfect and premature analysis of the costs and benefits,” he concludes.