“…This sounds like it should be straightforward, but in fact, the COVID situation presents a number of practical and ethical complexities that stretch the application of the QALY concept beyond its initial intended usage. This means that the QALY concept will need to be developed further so that it can be applied to an intervention: ‐ - designed to prevent rather than to treat – the issue of COVID‐19 susceptibility, in terms of both morbidity and mortality, needs to be factored into estimates of costs and benefits.
- that impacts the community as a whole rather than just susceptible or sick individuals – the impact of the lockdown on individuals with low susceptibility to the virus needs to be taken as seriously as those individuals with high susceptibility.
- where QALY losses may be more common than gains – so that the negative effects of lockdown felt by the community as a whole are set against the positive effects limited to a minority of COVID‐susceptible individuals – this is complicated further, of course, for instance, by the knock‐on lockdown benefits in terms of quality of life associated with bereavements avoided (Kidman, Margolis, Smith‐Greenaway, & Verdery, 2021) and the knock‐on costs in terms of reduced life expectancy due to missed diagnoses and treatments.
- where QALY losses and gains have qualitatively different profiles – lockdown‐related QALY losses relate more to quality of life, while gains relate more to increased life expectancy. But see caveats above.
- that have an imbalance of impacts between and within demographic groups – for instance, COVID‐19 susceptibility, and therefore lockdown gain, is likely to be concentrated in the older age groups, especially those with underlying health issues, while lockdown losses may be experienced most acutely by younger members of society ‐ where the personal health risks of infection are very small.
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