Cost and benefit

Personalising risk and personalising cost.

NZ – Covid risk

Based upon current average death numbers at 1,500 per million, over 2 years.
Average age of death being 82 – life expectancy without Covid interference an additional 3 years.
So 1,500 x 5m pop. = 7,500 x 3 years = 22,500 life years.
On average at the end of life – low quality life years in most circumstances.

Expediture on Covid

Lets say it’s only 1 Billion – the cost of a single week of lockdown.

Comparative expenditure

In this example we will use the funding for Keytruda immunotherapy.
Ironically funding negotiations for this were cancelled by this Government citing the cost of Covid.
Only funded currently for inoperable melanoma, we will use it as required for cancers of the head, neck, edometriotic, lung and other cancers for which it has a proven performance.
30-50 people per week (say 40) given, on average, an additional 3-5 years of life (say 4).
Figures quoted for funding are \$50-200m for 3-5 years. Lets say \$100m for 4.
So:
40 people per week (say 2,000 people per annum) funded for 4 years = 8,000 people,
getting 4 years extra life on average, 32,000 life years in total.
\$100m = 32,000 life years – average onset age? (lets say 65) higher quality of life years than Covid.
However we have only spent \$100 million, so multiply the results x10
1 billion = Keytruda funded for 40 years saving 320,000 life years.
Note: It is not clear in the figures I have what length of time the treatment is applied, I have used 1 year.
Though it was worded as 3-5 years accumulative, So else – use between 80,000 and 320,000 life years.
Have we spent 50x times that on our Covid response? Or even more?
All public health decisions are ultimately \$/risk/benefit analysis, how can this be justified?

Personalising risk and cost.

We hear at the moment things like “You are killing your Gran” etc.
Fine – but that statement personalises the risk, it does not personalise the cost.
Using the costs above as an indication – and I doubt they can be wrong by a factor of 50x –
A more honest statement might be …
“Save your Gran – but kill 10 other members of your family: children, siblings and/or cousins”.

Points on conclusion.

This is of course based on a zero sum game that assumes the budgeted money would be spent where it does the most good. The fact is it would probably not be spent at all on boring diseases.
Has anyone asked anyone over 80 whether they would prefer another year of life on the basis that they deny one of their children another year of life at age 60 – let alone?
My personal opinion of a preferred action would be to vaccinate often the 70 plus age group and the vulnerable. Then carry on as “old normal” zero restrictions. Perhaps take \$10B and sprinkle a few modern base hospitals about the place. Spend another \$5B on the like of Keytruda above and clearing some of the elective surgery lists. Of course there is still the other \$35B!
What would you do?