Why standard ways of assessing health during the pandemic were set aside

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QALYs are often used to assess the value of medications and other interventions to improve health. Credit: sfam_photo / Shutterstock

Governments around the world responded initially COVID-19[feminine[feminine according to the most important goal: to save lives. But as the pandemic continued to affect both health and finances, questions began to arise about what the right approach should be: protecting health or protecting the economy, or both. Implicitly, governments around the world began to consider one compensation between the two in their decision making.

Making decisions on these matters is difficult. There is always more than one way of doing things. We call these alternatives “competing measures.” When it arises i , governments have had at their disposal alternatives at different levels: closed versus less strict (or none) closures, open schools and universities versus online-only education, open versus closed borders, and so on.

Each alternative causes both positive and positive . Being able to select one requires answering difficult questions. What more economic downturn are we willing to accept for every life that would be saved with a closure? Or conversely, how many more deaths are we willing to accept in exchange for increased economic and other activities?

A to address these difficult issues is to apply economic assessment tools: measures to estimate the real cost of efforts to protect people’s health, such as quality-adjusted life years (QALYs). However, they have not been used.

How QALYs work

QALYs are a measure of good health that an intervention provides. They measure not only the years of life saved by an intervention, but also how the years of life saved would be disability-free. A measure that provides a year of perfect health provides a QALY; if it provides a compromised year of life (for example, due to a disability or chronic illness), it only provides a fraction of the QALY.

One way the Uses of the United Kingdom QALYs is in the NHS, to determine if new and expensive treatments should be provided. QALYs make these decisions explicitly and transparently. By estimating both the treatment costs and the QALYs obtained, you can judge whether it offers good value.

In the NHS, if the cost per QALY earned is between 20,000 and 30,000 pounds (or up to £ 50,000 in the case of end-of-life treatments), the intervention is considered cost-effective by the healthcare monitor, NICE. Other government departments also use QALY, although they can use it different thresholds depending on the specific context. The UK Department of Health and Finance uses a threshold above the NHS, for example: £ 60,000 for QALY.

But despite their demonstrated strength in making explicit and transparent health decisions, British governments have not used QALY during the pandemic response. Researchers have estimated that, for example, every QALY saved through security locks could have cost the country hundreds of thousands or even millions of pounds.

These estimates are well above the traditional thresholds used by NICE and others. Why has this happened?

These are not normal times

COVID-19 is an emergency. And one thing that differentiates emergencies from normal times is the high level of risk aversion which prevails by uncertainties.

In a situation unknown as a pandemic, the real impact of the problem on health is unknown. The scale of other impacts, such as economic damage, is also calculated highly challenging due to the novelty of the situation. In these situations it is very difficult to accurately calculate the scale of economic damage.

In such situations, the authorities tend to be wrong out of prudence. Experience shows that, when so much is unknown, the desire to prevent the pandemic from having a huge and uncontrollable health impact outweighs the desire to assess economic costs.

Moreover, at various times in the pandemic, these unknowns have not been the same. The available hard data it has shown not only terrifying rates of viral transmission, but increasing mortality rates and the threat that the NHS will overwhelm. If the most specific information in a situation of uncertainty points to drastic consequences for people’s health, it is not uncommon for risk aversion and health protection to be prioritized over saving money.

For these reasons, despite the requests used, cost-benefit measures such as QALYs have never been implemented. As a result, rough estimates of the costs of saving a QALY have ended up being well above the thresholds commonly used in the UK.

Unfortunately, we are still in a highly uncertain situation with no significant data on the broader impacts of the different measures used to control the virus, beyond infection, hospitalization, and mortality rates. There are also additional factors, such as the emergence of new variants of the coronavirus, that can quickly change the possible health impacts of the pandemic. Therefore, the application of the economic rules of normal times governing health decisions, while desirable, is not yet feasible for the foreseeable future.

But what we should definitely do is collect more retrospective data on the economic and broader consequences of this crisis, so that we have more information at our disposal in future crises.

For example, while the cost per QALY saved in developing or deploying any of the COVID-19 vaccines was not taken into account, modeling suggests that vaccines appear to offer good value for money when considering the costs and health deaths they avoid. Gathering information like this can help us build more robust economic models for specific situations and help legitimize health spending decisions in future pandemics.


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Citation: Why Standard Ways to Assess Health During the Pandemic (2021, June 9) Retrieved June 9, 2021 at https://medicalxpress.com/news/2021-06-standard-ways -valuing-health-pandemic.html

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