The issue of the cost effectiveness of measures taken to tackle COVID-19 are discussed in a BMJ feature article by John Appleby, director of research and chief economist at Nuffield Trust in the UK.
Appleby notes that whilst it is hard to discuss the economics of COVID-19 whilst in the midst of an "unprecedented global emergency" during which measures are being taken to minimise mortality and morbidity, the question of cost benefit is one that all health systems routinely face. Although determining cost effectiveness may be viewed as a somewhat "heartless utilitarian" process, it is essentially concerned with fair use of scarce resources. However, this can be hard to apply when rescuing people in emergency situations, which leads Appleby to raise the question "does cost effectiveness even have a role when it comes to covid-19 − undeniably an emergency?".
Although modelling has estimated that the number of lives lost due to COVID-19 in the UK could range from up to half a million over two years in the "do nothing" scenario, down to 250 000 with a combination of non-pharmaceutical and treatment intervention, there is still significant uncertainty about the impact of the pandemic and these figures represent best estimates that are subject to changes as the pandemic evolves. To provide context, the total number of deaths in 2018 in the UK was 616 000.
Appleby comments that "[t]here are, and will be, therefore, undoubted benefits from the interventions the UK has been pursuing to mitigate the impact of covid-19 − to "flatten the curve"" but goes on to discuss the "ugly" question of whether the value of the benefits of the interventions is more than the opportunity costs. Economic as well as health and healthcare components will contribute to the costs, with opportunity costs including mortality and morbidity from non-COVID-19 conditions due to reduced or delayed health services. Indicative figures from the UK Office for National Statistics suggests there were 6082 more all-cause deaths in the week ending 3 April 2020 for England and Wales compared with the five-year average for this week, compared with 3475 deaths from COVID-19 in this period, although how many of the "excess" deaths are a result of COVID-19 interventions or changes in healthcare-seeking behaviour remains to be seen.
The US has early estimates suggesting a net benefit of isolation and social distancing compared with the negative impact on the economy, although these are largely uncertain. However, the balance of cost-benefit could change depending on multiple factors such as extra tests, more ventilators, increased personal protective equipment and vaccine development. Appleby concludes that for now, given the nature of the pandemic, "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".