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        Mass testingCoronavirus: As a Health Economist, I’m Not Convinced the Case for Mass Testing Stacks Up

        By Cam Donaldson

        Published 2 April 2020

        Health economists think in terms of benefits from a course of action: lives saved, years of life saved and something we call quality-adjusted life years saved or QALYs. Yet in the present crisis, the data to make such calculations is likely to come too late. In a situation with (perceived) high risks and an immediate impact, there is a “rule of rescue” that says you decide now, still using rational reasoning, and worry about the QALYs later. So here’s my perspective as a health economist about the best way forward.

        In 1974, a classic book, Who Shall Live?, was published. Written by Victor Fuchs, a Stanford University professor, it marked the birth of health economics. It arrived at a moment when the post-war era of continued growth in public services was becoming unsustainable – just as treatment options for patients were expanding and the public expected more and more from their health services.

        Governments and their healthcare systems were trying to respond – and Who Shall Live? gave them a framework. A famous example often quoted in my student days at the University of York in the early 1980s was renal dialysis. Though not widely known by the general public, many publicly funded healthcare systems rationed this treatment. Older patients sometimes missed out, reducing their life expectancy by a few years.

        Thankfully, such drastic rationing has become rare – cropping up mainly with certain expensive late-stage cancer drugs. Yet as we address the COVID-19 crisis, this is changing.

        Health economists think in terms of benefits from a course of action: lives saved, years of life saved and something we call quality-adjusted life years saved or QALYs. Yet in the present crisis, the data to make such calculations is likely to come too late. In a situation with (perceived) high risks and an immediate impact, there is a “rule of rescue” that says you decide now, still using rational reasoning, and worry about the QALYs later. So here’s my perspective as a health economist about the best way forward.

        Mass Testing
        It is not made explicit to the public, but those in charge of health policy will already have been carrying out multi-layered calculations into the relative costs and benefits of different testing strategies. This explains, for instance, why the U.K. is prioritizing testing healthcare workers, since keeping them free of infection has the potential to save many more lives.

        The country is testing fewer than 10,000 people a day at present, with the government saying it will reach 25,000 per day by the middle of April. Yet, with well over a million workers in the NHS, this will take several months to complete – and that is without counting other key workers and also symptomatic patients in whom the virus ought to be identified so that they can be isolated.

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