• David K Miles, Michael Stedman, and Adrian H Heald.
• Imperial College Business School, London, United Kingdom.
• Int. J. Clin. Pract. 2021 Mar 1; 75 (3): e13674e13674.

IntroductionThe 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.MethodsWe 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).ResultsThere 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.ConclusionThis 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.© 2020 The Authors. International Journal of Clinical Practice published by John Wiley & Sons Ltd.

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