"Stay at Home, Protect the National Health Service, Save Lives": A cost benefit analysis of the lockdown in the United Kingdom

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.

Keywords: COVID-19; economics; strategy; unlock.

FIGURE 1

Excess Deaths in weeks 8‐21 of 2020. Difference to average in the same week in the previous 3 years (2017/2018/2019) and shown as % of average. Source: The Human Mortality Database Department of Demography at the University of California, Max Planck Institute for Demographic Research, Center on the Economics and Development of Aging (CEDA) www.mortality.org. Downloaded 9/6/2020

FIGURE 2

Date of Implementation and Relaxation of National responses in selected countries. The series is the COVID‐19 Government Response Stringency Index which is a composite measure based on nine response indicators including school closures, workplace closures, and travel bans, rescaled to a value from 0 to 100 (100 = strictest response). Source: Blavatnik School of Government, University of Oxford, https://www.bsg.ox.ac.uk/research/research‐projects/coronavirus‐government‐response‐tracker

FIGURE 3

Net extra economic costs of the lockdown relative to the easing of restrictions are assumed to be £100 billion. To that is added the cost of lives lost under lockdown. The benefits of lives not lost, relative to the easing of restrictions, is then deducted from the lockdown costs to generate a net cost figure under the three scenarios. The easing scenarios are: (a) deaths still decline but slower than in Lockdown, (b) deaths remain at start June 2020 levels (c) deaths increase again back up to April 2020 peak levels. The equivalent cost/QALY is calculated by dividing the Lockdown costs (£100 billion) by the net number of lives not lost in that scenario times the number of Quality‐Adjusted Life Years (QALYs) for each death