Consideration of Trade-offs Regarding COVID-19 Containment Measures in the United States

Background: The economic stimulus package in the United States, which totalled $2.48 trillion, was designed to soften the economic impact of sweeping containment measures including shelter-in-place orders that were put in place to control the COVID-19 pandemic.Methods: In healthcare, interventions are rarely justified simply in terms of the number of lives saved but also in terms of a myriad of other trade-off factors including value-for-money or cost-effectiveness. Cost-effectiveness analysis was therefore conducted as the cost per life-year gained (Cost/LYG) from the containment measures adopted based on several different projections of the baseline number of deaths in the absence of any containment measures. Reductions in premature mortality due to the shutdown (i.e. the difference between years of life lost relative to life expectancy under the shutdown and no shutdown scenarios) were used to calculate changes in health status. Given that men and women have different life expectancies, the analysis calculates premature mortality for men and women by age bracket. Results: The results showed seven different scenarios that reflect different death projections. It showed that as the projected number of deaths increases, the cost-effectiveness of the containment measures becomes more favourable i.e. providing better value-for money for US taxpayers. Cost-effectiveness ranged from $180,874 per life-year-gained for the high-end projection to $4,258,780 per life-year gained for the low-end death projection estimate.Conclusion: Incremental costs per life-year gained related to the economic shutdown can span a wide range depending on the baseline number of deaths in the absence of any containment measures. The results show that in the US, under no scenario for life-years gained does the stimulus package compare favourably to other healthcare interventions that have had favourable cost-effectiveness profiles. However, when comparing value-of-statistical-life-year (VSLY) threshold measures used in other sectors, it is plausible that the U.S. stimulus package could be viewed more favourably from a cost-effectiveness perspective. Given the wide-ranging impacts that COVID-19 has had on American life, it would seem that the comparison should be made to experiences in multiple sectors and on this basis, it appears that the shutdown is likely to represent good value-for-money.