Why the standard method of assessing health was abolished during the pandemic

Governments around the world first responded COVID-19 (New Coronavirus Infection) The only most important purpose is to save lives. However, as the pandemic continued, affecting both health and finances, the question began to arise as to whether to focus on health protection and / or economic protection. Implicitly, governments around the world Trade off Make a decision between the two.

It is difficult to make decisions on these issues. There are always multiple ways to get things done. We call these alternatives or “competitive measures”.When considering health And Economic benefits, The government had free choices at various levels: strict lockdowns and less strict lockdowns (or no lockdowns at all), open schools and colleges and online-only education, open borders. And closed borders.

Each option is positive Negative resultsTo choose one, you have to answer difficult questions. How much can we tolerate a downturn in the economy for every life saved by lockdown? Or, conversely, in exchange for increased economic activity and other activities, we are willing to kill more. Do you accept?

Ah Standard practice To deal with these difficult problems, you need to apply economic valuation tools. This is a way to estimate the actual cost of efforts to protect people’s health. Quality-adjusted life years (quality). However, these have not been used yet.

How QALY works

QALY is a measure of how well an intervention results. They measure not only the number of years of life expectancy saved by the intervention, but also how many years of life expectancy saved were unimpaired. An indicator of complete health for a year provides one QALY. Only a small portion of QALY is offered when providing a one-year lifespan that is compromised by disability or chronic illness.

One way Used in the UK QALYs are in the NHS to determine if new and expensive treatments need to be offered. QALYs make such decisions explicitly and transparently. By estimating both the cost of the treatment and the QALYs obtained, you can determine if the treatment is worth it.

In the NHS, the acquisition cost per QALY is Between £ 20,000 and £ 30,000 The intervention is considered cost-effective by the medical oversight agency (or up to £ 50,000 for some end-of-life treatments). niceOther government departments also use QALYs, Various thresholds Depending on the particular context. The UK Ministry of Health and Treasury use higher thresholds than the NHS. For example: £ 60,000 per QALY..

However, despite solid strengths in making health care decisions clear and transparent, QALYs have not been used by the UK government during pandemic responses. Researchers have been saved, for example, by lockdowns. We estimate that each QALY may have influenced the country. Hundreds of thousands Or Millions Of pounds.

These estimates are much higher than the traditional thresholds used by NICE and others. Why did this happen?

Not in peacetime

COVID-19 is an emergency. And one of the differences between emergencies and normal times is High risk aversion It predominates because of uncertainty.

In unfamiliar situations such as pandemics, the actual health effects of the problem are unknown. You can also calculate the magnitude of other effects such as economic damage Very challenging Because of the novelty of the situation. In such situations, it is very difficult to accurately calculate the magnitude of economic damage.

In these situations, authorities tend to act cautiously. Experience has shown that, when much is unknown, the desire to avoid a pandemic’s enormous and uncontrollable effects on health is more important than the desire to assess economic costs.

Moreover, at multiple points during the pandemic, these unknowns were not equal.Available Hard data Not only are virus infection rates horrifying, but mortality rates are also rising, threatening to overwhelm the NHS. When more specific information in an uncertain situation shows that it has dramatic consequences for people’s health, risk aversion begins and protecting health is prioritized over saving money. Is not surprising.

For these reasons, despite the demand for use of QALYs, no cost-effective measures such as QALYs were considered. As a result, the rough calculation of the cost of saving QALYs is much higher than the threshold normally used in the UK.

Unfortunately, we remain in a very uncertain situation without meaningful data on the broader impact of the various measures used to control the virus, beyond infection, hospitalization and mortality. .. There are also additional factors that can rapidly change the potential health effects of a pandemic, such as the emergence of new variants of the new coronavirus. Therefore, the application of peacetime economic rules governing health care decision-making, while desirable, is not yet feasible in the foreseeable future.

But what we need to be sure is to collect more retrospective and more reliable data about the economic and broader consequences of this crisis. Doing so will give you more information at your disposal in case of a future crisis.

For example, the cost per QALY saved is not taken into account in the development or deployment of the COVID-19 vaccine, but modeling suggests that the vaccine appears to provide. Good value for money When considering medical costs and the deaths they avoid. Gathering such information will help build a more robust economic model for future situations and justify decisions on medical spending in future pandemics.

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