Abstract
This paper conducts a cost–benefit analysis of Australia’s Covid-19 lockdown strategy relative to pursuit of a mitigation strategy in March 2020. The estimated additional deaths from a mitigation strategy are 11,500 to 40,000, implying a Cost per Quality Adjusted Life Year saved by locking down of at least 11 times the generally employed figure of $100,000 for health interventions in Australia. The lockdowns do not then seem to have been justified by reference to the standard benchmark. Consideration of the information available to the Australian government in March 2020 yields a similar ratio and therefore the same conclusion that lockdown was not warranted. If Australia experiences a new outbreak, and cannot contain it without resort to a nationwide lockdown, the death toll from adopting a mitigation strategy at this point would be even less than had it done so in March 2020, due to the vaccination campaign, lessons learned since March 2020, and because the period over which the virus would then inflict casualties would now be much less than the period from March 2020. This would favour a mitigation policy even more strongly than in March 2020. This approach of assessing the savings in quality adjusted life years and comparing them to a standard benchmark figure ensures that all quality adjusted life years saved by various health interventions are treated equally, which accords with the ethical principle of equity across people.
Introduction
As with most other countries, in early 2020 and in response to Covid-19, Australia’s federal and state governments implemented substantial general restrictions on mobility and economic activities involving the closure of non-essential businesses and confinement of the general public to their homes except for defined purposes (“lockdowns”). Since then, the restrictions have been substantially relaxed, but with temporary reinstatements in different parts of the country. This paper conducts a cost–benefit analysis (otherwise called a cost-effectiveness analysis) of this lockdown strategy relative to a milder strategy involving case isolation, quarantining of members of their households, limiting large gatherings, social distancing in public spaces, border controls, and restrictions targeted at only high-risk groups (“mitigation”). This alternative was selected because it was the most widely contemplated alternative to lockdowns and could be expected to involve significantly lower costs. The population of concern is that of Australia. The Covid-19 deaths estimated are those over the period until the end of 2021 (on the basis that mass vaccination will be completed by then and therefore any case for lockdowns will cease at that point). The costs examined are society-wide costs without limit on the time horizon over which they are incurred because they can extend beyond the point at which lockdowns cease (but constrained by the difficulties in estimating longer term costs).
The paper commences by examining the optimal decision in March 2020 using data available as at 28 June 2021. It then considers the optimal decision based on information available at the time of the initial lockdown decision. Finally, it considers the optimal course of action now if a new outbreak occurs that cannot be contained without resort to lockdowns.
Conclusions
This paper has conducted a cost–benefit analysis (otherwise called a cost-effectiveness analysis) of Australia’s Covid-19 lockdown strategy relative to pursuit of a mitigation strategy in March 2020. The estimated additional deaths from a mitigation policy are 11,500 to 40,000. The result is that the cost per Quality Adjusted Life Year saved by locking down is estimated to be at least 11 times the generally employed figure of $100,000 for health interventions in Australia. The lockdowns were therefore not justified by the standard methodology. Consideration of the information available to the Australian government in March 2020 yields a similar ratio and therefore strongly supported adoption of a mitigation strategy at that time. If Australia experiences a new outbreak, and cannot contain it without resort to a nationwide lockdown, the death toll from adopting a mitigation strategy at this point would be even less than had it done so in March 2020 due to the vaccination campaign, lessons learned since March 2020, and because the period over which the virus would then inflict casualties would now be much less than the period from March 2020. This would favour a mitigation policy even more strongly than in March 2020. This approach of assessing the savings in quality adjusted life years and comparing them to a standard benchmark figure ensures that all quality adjusted life years saved by various health interventions are treated equally, which accords with the ethical principle of equity across people.
Source – https://link.springer.com/article/10.1007/s40592-021-00148-y