Sir, – I would commend the courage shown by Mark Paul in asking what level of expenditure is appropriate in seeking to prevent a death from Covid-19, or indeed from other causes ("How many fatalities are acceptable before Covid-19 restrictions kick in?", Business, Opinion, October 22nd).
The logic he mentions used by the Scientific Advisory Group for Emergencies (Sage) in the UK, and also by their National Institute for Clinical Excellence, values a year of good quality life at £30,000. An extension of this idea is the “quality adjusted life year”, such that, say, a year which is estimated at being of only 50 per cent of peak quality is thus valued at £15,000. A medical treatment is justified by this logic if, for that cost or less, it can deliver such a quality of life. Ultimately, one might debate at length the quality of life a given individual already enjoys, and even more so what they might experience in the future. But at least such pragmatism creates some framework for these discussions. Meanwhile, the cost of hospital admission – about €1,000 per day generally and slightly over €2,500 in intensive care – can be weighed up against such predictions.
The logic of the Sage group emanated from the opinions of scientific and medical experts. Noting that Mark Paul’s article featured in the business section of the newspaper, it’s worth considering that from a commercial angle two other radically different approaches can be taken to the determine the value of human life in such a context.
In the early states of the Covid pandemic, much credit was paid to the South Korean state for its effective response to the pandemic. Part of the reason for their preparedness can be traced back to a Middle East Respiratory Syndrome (Mers) outbreak there in 2015. It involved 186 cases and caused 38 deaths. The estimated impact on tourism alone was $2.6 billion, or about $14 million per case (Joo et al, Health Security 2019). The full impact on their economy was perhaps four times as high. Thus they were ready to act rapidly when Covid-19 appeared, fearing the costs of inaction.
An entirely different approach, which incorporates the logic of insurance, is to look at the premium workers are paid to take on high-risk occupations and to correlate the excess payment with the actuarial risk they assume. For example a profession that carries a 1 per cent risk of death will attract extra payment.
If that excess is multiplied by 100, then the market value of a life can, as offensive as it sounds, be quantified. This logic in the US gives a figure of about $10 million.
In healthcare resourcing one must also at times factor in the opportunity cost, which is particularly relevant to ICU admission. Once such a bed is occupied by a patient, the space and its associated input are unavailable to others. This during Covid has lead to the odd consideration of how much resourcing can be focused on a disease for which there is arguably no effective treatment and thereby steered away from eminently treatable ones. While there is no easy answer to that, it does put the matter into stark relief.
It also raises the question of vaccine refusal, and the freedom that entails. While encroaching upon that seems unthinkable, the freedom grants the refusenik the capacity to consume enormous quantities of tax revenue, while disrupting the treatment of others who did not choose to take any such risk.
As discomfiting as these questions are, they cannot be entirely avoided. They trickle into areas from tourism to business and insurance, as much as healthcare, budgeting and hospital administration. Most doctors are aware of the logic adopted by Sage and, as Mark Paul suggests, a national discussion on this subject is necessary. There is clearly no way to eliminate all risk and, as a society, we can only make trade-offs.
Well done again to your columnist for having the courage to raise the topic. – Yours, etc,