Might it be that the calculations massively understate the benefits of
lockdown? That would be the case if the value of lives saved is
dramatically too low; some would say that it is. Estimates used in the
US for the statistical value of a life place it slightly above $10
million (29,30). For a newborn who might expect 80 good years of life
the NICE £30,000 number would generate a life value of £2.4 million –
just under a third of the value if a statistical life is worth $10
million. Goldstein and Lee (2020) (31) note that US health economists
use values of around $125,000 per year of life (Institute for Clinical
and Economic Review 2020). That is also a bit over three times the NICE
figure.
However, the £30,000 figure per QALY is the figure used in
evidence-based resource decisions within the UK health system. It is not
an arbitrary number. It is not based on likely future earnings lost or
the value of future consumption – calculations that are open to the
moral objection that they reduce the value of human life to how much
people would have spent on commodities.
Instead, the figure we use for the value of a QALY is a measure of what
is considered the highest level of resources (i.e. what part of GDP) in
the UK health system that should be used to generate extra
quality-adjusted years of life – and it is saving of lives which is
what the lockdown was for. In using this yardstick, we are treating
decisions on how to face COVID-19 in the same way as decisions in the UK
are made about resources to apply to the treatment of cancer, heart
disease, dementia and diabetes. On that basis, it would seem as though
the benefits of the lockdown were lower - perhaps far lower- than its costs. Yet even if
one used valuation of a QALY three times as great the figures in Tables
2 and 3 (with benefits raised by a factor of 3) that would still
generate costs of the lockdown in excess of benefits in nearly all the
cases considered.
That judgement is, however, made with the benefit of hindsight: we now
know more about the scale of the economic costs of the lockdown than was
known in March, and also know about how deaths and new infections have
evolved across Europe. The more interesting policy issue is what it is
best to do now: how quickly should the lockdown be eased given what we
know now? That issue we consider in the next section.