Why is there no sensible health economics debate around Covid?

[covidity]

There has ALWAYS been a balance struck by successive governments between the cost of treating disease and its benefit.
This is why NICE was founded and why various new treatments e.g. for cancer are rationed or not available at all on the NHS.

When looking at treatments, NICE generally looks to approve those whose 'cost per life year saved' is no more than approx £20,000-£30,000.
So a life-saving treatment for a 10 year old is likely to be such better value, as it has saved approx 75 years of life for that child.

By contrast, a life-saving treatment for a 75 year old will be assessed as much poorer value, as it has saved approx 10 years of that for that person.

It may seem harsh to look at treatments in this way, but it is already done by NICE to decide which drugs will be funded by the NHS.

Why isn't this information publicised by the media so we can have a well-informed debate about covid in a similar way? Reports I see are generally sensationalist headlines with no real context, science or analysis.

As a population we need a grown-up debate around this. Why is Covid so special? It should be subject to the same health economics as everything else the population faces.

Our civil liberties are worth fighting for. I want to be able to see my own family. There has been no scientific justification for any actions since August, let alone the overwhelming evidence which should be required before ignoring democracy.

I am extremely concerned, nut about the virus, but about the behaviour of a democratically elected government.

I meant to add that the Covid cost currently runs at £180,000 per life year saved vs the usual £20-30,000 which is permissible by NICE.

These calculations were published by Simon Wood, Professor of Computational Statistics at the University of Edinburgh, so not done on the back of a fag packet!

You think the NHS chiefs aren't considering this?

We also live in a, well supposedly, caring society, that although we have to accept not everyone can be healed leaving people to end their lives frightened and in pain is also not what is acceptable.

It seems Covid is "so special" because potentially hundreds of people can turn up at the same time requiring life-saving treatment. And no medic wants to ration treatment as that involves making almost impossible decisions.

Which life saving treatments would you like to withdraw from covid patients to balance the books?

No medic wants to ration treatment as that involves making almost impossible decisions

This is part of the usual working day for many medics.

It's not just lives/deaths. There's manner of death.

In order to try to keep down the numbers of those dying from one particular condition, we are condemning thousands to die alone, without the support of those they know and love.

No one is talking about it because the gov are still coy about being Conservative.
It's not a pleasant choice but they've spent years convincing us society is expensive and personal gain is the goal so it's no surprise that econo.y comes first.

If the economy tanks we all suffer but the top 5% will suffer most.
If we keep the economy priority we all suffer but more vulnerable die and the top 5% aren't affected.

Conservatives will prioritise the economy.

We are in a pandemic, it’s not the same as rationing or limiting new treatments for non infectious diseases. Cases will increase exponentially, until it is unmanageable.

Without some restrictions we run the risk of the NHS being overwhelmed, which would lead to increased deaths from all causes, not just Covid.

Then there are societal impacts of having a sizeable percentage of the population sick at once - will you have enough emergency services staff available? At one during the 1918 Spanish flu pandemic 1400 Met police officers were off sick at once.

Will you have the manpower to properly bury or cremate the dead, or will we be looking at mass graves? Society soon begins to break down. It’s not just about preventing Covid deaths.

@FourTeaFallOut your comment is a good example of why we need a population who are able to think critically rather than emote.

In a perfect world everyone would be treated for everything with no consequences for the rest of the population. Unfortunately every decision around this pandemic has consequences and it is the balance to be struck which needs a well-informed educated population and a grown-up debate. Unfortunately that seems to be a long way off, particularly when governments seem to react to opinion polls based on what people think they should say rather than how they actually behave.

@covidity

There has ALWAYS been a balance struck by successive governments between the cost of treating disease and its benefit. This is why NICE was founded and why various new treatments e.g. for cancer are rationed or not available at all on the NHS.

When looking at treatments, NICE generally looks to approve those whose 'cost per life year saved' is no more than approx £20,000-£30,000.
So a life-saving treatment for a 10 year old is likely to be such better value, as it has saved approx 75 years of life for that child.

By contrast, a life-saving treatment for a 75 year old will be assessed as much poorer value, as it has saved approx 10 years of that for that person.

It may seem harsh to look at treatments in this way, but it is already done by NICE to decide which drugs will be funded by the NHS.

Why isn't this information publicised by the media so we can have a well-informed debate about covid in a similar way? Reports I see are generally sensationalist headlines with no real context, science or analysis.

As a population we need a grown-up debate around this. Why is Covid so special? It should be subject to the same health economics as everything else the population faces.

Our civil liberties are worth fighting for. I want to be able to see my own family. There has been no scientific justification for any actions since August, let alone the overwhelming evidence which should be required before ignoring democracy.

I am extremely concerned, nut about the virus, but about the behaviour of a democratically elected government.

Civil liberties ? Really ? What about the rights of people classed as BAME, children that are medically vulnerable (type 1 diabetes let's say) who have their whole lives ahead of them and their parents and carers that are contributing members of society ? I'd like as a person with no health problems to think that we are all equal and happy to make sacrifices for the benefit of all. We know that the virus loves an indoor environment with close contact (people in houses for example) so why when we know this do we continuously question it ? The rules put in place are temporary and will be reviewed accordingly, death and long term covid are not unfortunately.

We are not living in a 3rd world or war torn country or even close,
we have civil liberties. Brexit will perhaps lead to far worse economic and societal problems and even has the potential leave workers with about as many employment rights as they have in the US and yet here we are banging the poor old me drum. Yes it's rubbish and yes it's annoying but we all need to work together and view all lives equally.

Maybe just answer the question?

I'm still waiting.

Surely, given you want to have a rational economic discussion of the financial cost of covid treatments you have some of the basic figures to hand?

Surely you didn't want to have a cold hard talk about health economics by just blowing hot air around?

I don’t believe the OP was talking about withdrawal of treatment from Covid patients?

If the economy tanks we all suffer but the top 5% will suffer most.

That is simply not true. It's the least well-off in society that always suffer the worst of the economic fall-out, as they have already during the covid measures. The wealthiest are very well-insulated, and have in fact in many cases increased their wealth in the last few months: www.theguardian.com/business/2020/oct/07/covid-19-crisis-boosts-the-fortunes-of-worlds-billionaires

They're not talking about it because it's not of primary relevance here. There is a popular misconception that there is a binary choice between controlling covid and a suffering economy.

Were the government to decide that people with covid over xx years old would, effectively, be allowed to die this would not have a positive impact on our feeling of safety and confidence, and thus our likelihood of going out and about spending money.

I don't understand what thus debate would achieve, other than to deepen division at a time when we need greater unity.

Aye Max I agree I worded that wrong.
It should be the 5% will also suffer not suffer most.

The op says that the current covid treatments do not represent good value for money and exceed Nice guidelines by many tens of thousands. "Why is covid so special", he bemoans (I'm assuming op is a man) yada yada. "Why isn't this information publicised by the media so we can have a well-informed debate about covid in a similar way?"

Unless the op has conflated just covid treatments with covid measures?

I don't think trying to price up the cost of shielding etc. will add to the quality of this debate to be honest.

We need to minimize the spread of the virus and also minimize the exposure of the vulnerable. While also trying to keep the economy going.

I don't think there is an easy answer; we are going to have to do things a bit differently until we have more medical knowledge, more treatments, maybe a vaccine. It's tough.

In my local area, people are pulling together, helping with shopping, trying to support local businesses.

I think that's what we need, together with sensible, considerate behaviour around keeping infection levels down.

What would make you assume OP is a man?

Mostly writing style, I think. I'm not invested one way or another, could be a woman.

@TheQueef my apologies in which case x

Skimming the daily mail, the costs of covid is being allocated to the people who have had covid and not died

should it actually be allocated against the people who don't get it and don't die

And shouldn't the costs be the net costs not gross costs, so including the economic impact of not controlling the virus , which is generally accepted to be more than the costs incurred through controlling it ?

[quote covidity]@FourTeaFallOut your comment is a good example of why we need a population who are able to think critically rather than emote.

In a perfect world everyone would be treated for everything with no consequences for the rest of the population. Unfortunately every decision around this pandemic has consequences and it is the balance to be struck which needs a well-informed educated population and a grown-up debate. Unfortunately that seems to be a long way off, particularly when governments seem to react to opinion polls based on what people think they should say rather than how they actually behave.[/quote]
Was going to say exactly this. I think this thread shows clearly that people are still unable to have a grown up conversation about illness and death - especially when it's linked to Covid. The immediate labelling of anyone as a nazi,a eugenist,a monster because they dare to question any aspect of whether all these lives being "saved" is worth it is getting really tired.

It's not just cost vs lives saved.

Economy (spending) is also dependent on confidence so scenes like February/March in Italy definitely need to be avoided.

Staffing, both of hospitals and vital services. Staff in hospitals are both at risk of worse symptoms (viral load) and of spreading it to vulnerable patients if asymptomatic. Other services need people to be fit to work, and exponential growth even of milder symptoms (say "normal flu" type of the curl up in a ball for 2 days, feel groggy for a week and not fully better for a month variety) and ignoring "long Covid" will be bad for vital services like the NHS, transport, utilities, food etc if enough people are just a bit ill for a month each!

There's also the