Exploratory comparison of Healthcare costs and benefits of the UK’s Covid-19 response with four European countries
Authors: Thom Howard , Walker Josephine , Vickerman Peter , Hollingworth Will 
Published: December 2020

AbstractBackgroundIn responding to covid-19, governments have tried to balance protecting health while minimising Gross Domestic Product (GDP) losses. We compare health-related net benefit (HRNB) and GDP losses associated with government responses of the UK, Ireland, Germany, Spain, and Sweden from UK healthcare payer perspective.MethodsWe compared observed cases, hospitalisations, and deaths under “mitigation” to modelled events under “no mitigation” to 20thJuly 2020. We thus calculated healthcare costs, quality adjusted life years (QALYs), and HRNB at £20,000/QALY saved by each country. On per population (i.e. per capita) basis, we compared HRNB with forecast reductions in 2020 GDP growth (overall or compared to Sweden as minimal mitigation country) and qualitatively and quantitatively described government responses.ResultsThe UK saved 3.17 (0.32-3.65) million QALYs, £33 (8-38) billion healthcare costs, and £1416 (220-1637) HRNB per capita at £20,000/QALY. Per capita, this is comparable to £1,455 GDP loss using Sweden as comparator and offsets 46.1 (7.1-53.2)% of total £3075 GDP loss.Germany, Spain, and Sweden had greater HRNB per capita. These also offset a greater percentage of total GDP losses per capita. Ireland fared worst on both measures. Countries with more mask wearing, testing, and population susceptibility had better outcomes. Highest stringency responses did not appear to have best outcomes.ConclusionsOur exploratory analysis indicates the benefit of government covid-19 responses may outweigh their economic costs. The extent that HRNB offset economic losses appears to relate to population characteristics, testing levels, and mask wearing, rather than response stringency.Research in ContextEvidence before this studyOur research question was how the health-related net benefits and economic impacts of the UK response to the covid-19 epidemic first wave compared to other European countries. We searched PubMed, MedRxiv, and Arxiv for terms related to cost-effectivness, covid-19, and the UK.Two studies compared predicted lives saved to predicted gross domestic product (GDP) losses. One found that lives saved by a lockdown would outweigh GDP losses, while another found a lockdown to cost £10million per life saved. A later modelling study used quality adjusted life-years (QALYs), going beyond lives saved, and found cost per QALY was below £50,000. A fourth, comparing observed to modelled deaths and hospitalisations, found the cost per QALY was at least £220,000, and thus the UK response was not cost-effective. None of these were international comparisons. One international study found good health and economic outcomes to be correlated. Another found global trade reductions and voluntary behavioural changes to have greater impact on economic growth than government measures. Neither considered cost-effectiveness. However, they suggest comparison to GDP loss is naïve as this is total loss and not that due to government restrictions.Added value of this studyWe compare the UK to Ireland, Germany, Spain, and Sweden on health-related net benefits and economic impacts of government response from a UK National Health Service (NHS) perspective. We describe countries’ response measures. We compared model predictions of outcomes under “no mitigation” to observed outcomes under “mitigation” up to July 20th2020. We estimated healthcare costs, QALYs, and health-related net benefit (HRNB) saved. We compared HRBN to GDP losses using Sweden as a “minimal mitigation” comparator and calculated the % of total GDP loss they offset.We found the UK saved 3·17 (0·32-3·65) million QALYs, £33 (£8-38) billion in healthcare costs, and £1416 (220-1637) HRNB per capita at the NHS threshold of £20,000/QALY. This is comparable to the £1,455 GDP loss per capita using Sweden as comparator and offsets 46·1% (7·1-53·2) of the total estimated £3075 GDP loss per capita. We found that Germany, Spain, and probably Sweden had greater HRNB per capita and offset greater percentages of GDP loss per capita. Ireland fared worst on both measures. We found countries with more mask wearing, testing, and population susceptibility (e.g. older and more interpersonal contact) had better outcomes. Highest stringency responses did not appear to have best outcomes.Implications of all the available evidenceWe add to growing evidence that the total economic impact of covid-19 exceeds the HRNB of the UK’s response. However, using Sweden as comparator and comparing across countries, we argue that GDP loss is not purely due to government restrictions and that due to restrictions may be outweighed by HRNB. We evaluated the extent to which countries have offset GDP losses, and these appear to be higher in countries with more at-risk populations, higher testing, and higher mask wearing, rather than those with most stringent restrictions.