6 ms·

At $100k per quality-adjusted life-year and 10 QALY lost per death, those 5k deaths are $5B, about 1% of Sweden's GDP. So by the same math used to determine if

At $100k per quality-adjusted life-year and 10 QALY lost per death, those 5k deaths are $5B, about 1% of Sweden's GDP. So by the same math used to determine if medical treatments are cost-effective, it's breakeven if that GDP difference persists for about four months. We should also account for QALY lost due to people who get severely ill but recover, but I'd guess the net result is surprisingly close to breakeven. Perhaps this means the policymakers just chose different but roughly equivalent (by that math) options, or perhaps that's just chance. Of course you could say that math is horrible and inhumane, and any equation involving dollars and human lives will feel that way. But the point is that health care spending is already rationed by something like that standard, and every dollar of GDP that disappears is a dollar that's unavailable to spend in other ways (including medical treatments that are cost-effective by that standard). To be clear, I think Sweden erred by not mandating masks, which seem cost-effective to me by that standard. Their response otherwise seems reasonable to me, not obviously better than stricter approaches but not obviously worse.

nopinsight 6y ago
Plausible long-term damage to the brain of a significant percentage of COVID patients, in both severe and non-severe cases—-according to a Lancet paper—should change the QALY-based calculation by a great deal. https://mobile.twitter.com/yaneerbaryam/status/1290916583137738752 https://mobile.twitter.com/yaneerbaryam/status/1290916583137...
- femto 6y ago
  Perhaps the cost-benefit analysis should also include improvements in the technology to develop vaccines as a benefit? There's a good chance that the injection of resources into the development of COVID-19 vaccines will put us in a better position to respond to the next pandemic.
- timr 6y ago
  That is an incredibly bad paper. They have gone on a fishing expedition across dozens of algorithmically detected differences, barely adjusted their statistical significance thresholds to make up for the fact that they're searching for something that might be "significant", and even then, the best they can do is come up with...50% of people have something. A coin toss. This is the medical literature version of the xkcd green M&M comic: https://xkcd.com/882/ https://xkcd.com/882/
henrikschroder 6y ago
> 10 QALY lost per death Average age of the covid-19 dead in Sweden is 82, average life expectancy is 83. The majority of the deaths also occurred at elder care homes where the expected survival time is less than two years. And, just like everywhere else, the covid-19 dead are much more likely to belong to certain risk groups associated with earlier deaths as well. 10 QALY lost per death sounds way, way too high to me. > To be clear, I think Sweden erred by not mandating masks, which seem cost-effective to me by that standard. The reasoning behind this, which is the same in the rest of the Nordics and the Netherlands, is that a general mask mandate is counter-productive. No-one is arguing that medical grade face masks properly handled, worn, and disposed of help prevent the spread. The problem, and this should be obvious if you live in a place where masks are mandated, is that people don't have proper masks and don't wear them properly. So masks can create a sense of false security, and make people slack off on their distancing, which means a mask mandate can result in a net negative result. Right or wrong, I don't know, and I don't know if we'll ever know, but that's at least the reasoning behind it. And it definitely sounds plausible to me. I'm in Hawaii which has had a mask mandate for months now, and the way regular people are actually handling their masks in the real world is very, very far from the way trained medical professionals handle their masks.
- microtherion 6y ago
  > Average age of the covid-19 dead in Sweden is 82, average life expectancy is 83. That's life expectancy at BIRTH. It would seem to me that the relevant statistic in the case of an 80 year old dying is the average life expectancy they had at 80, which is considerably more than 3 years.
  - henrikschroder 6y ago
    You're right, but it's actually even more specific than that, you have to look at the life expectancy of a frail 80-year old living at an elder care facility suffering from diabetes/hypertension/heart problems. Not that of a random, healthy, 80-year old. The biggest disingeniousness of the people talking about the covid-19 specific death toll is that the assumption is that if not for covid-19, everyone would have lived forever and ever, and that's simply not true. Looking at the demographics of the dead, for many, covid-19 is what happened to push them over. If not for covid-19, something else would have done it in a similar timeframe, especially since the flu seasons of 2018/19 and 2019/20 were so mild. Yes, there are people who died significantly before their time, but they're a small minority of the dead. So 10 QALY lost per dead is way too much. 1 QALY lost per dead is too little, I agree. The truth is probably somewhere in between.

nopinsight 6y ago

Plausible long-term damage to the brain of a significant percentage of COVID patients, in both severe and non-severe cases—-according to a Lancet paper—should change the QALY-based calculation by a great deal. https://mobile.twitter.com/yaneerbaryam/status/1290916583137738752 https://mobile.twitter.com/yaneerbaryam/status/1290916583137...

femto 6y ago
Perhaps the cost-benefit analysis should also include improvements in the technology to develop vaccines as a benefit? There's a good chance that the injection of resources into the development of COVID-19 vaccines will put us in a better position to respond to the next pandemic.
timr 6y ago
That is an incredibly bad paper. They have gone on a fishing expedition across dozens of algorithmically detected differences, barely adjusted their statistical significance thresholds to make up for the fact that they're searching for something that might be "significant", and even then, the best they can do is come up with...50% of people have something. A coin toss. This is the medical literature version of the xkcd green M&M comic: https://xkcd.com/882/ https://xkcd.com/882/

henrikschroder 6y ago

> 10 QALY lost per death Average age of the covid-19 dead in Sweden is 82, average life expectancy is 83. The majority of the deaths also occurred at elder care homes where the expected survival time is less than two years. And, just like everywhere else, the covid-19 dead are much more likely to belong to certain risk groups associated with earlier deaths as well. 10 QALY lost per death sounds way, way too high to me. > To be clear, I think Sweden erred by not mandating masks, which seem cost-effective to me by that standard. The reasoning behind this, which is the same in the rest of the Nordics and the Netherlands, is that a general mask mandate is counter-productive. No-one is arguing that medical grade face masks properly handled, worn, and disposed of help prevent the spread. The problem, and this should be obvious if you live in a place where masks are mandated, is that people don't have proper masks and don't wear them properly. So masks can create a sense of false security, and make people slack off on their distancing, which means a mask mandate can result in a net negative result. Right or wrong, I don't know, and I don't know if we'll ever know, but that's at least the reasoning behind it. And it definitely sounds plausible to me. I'm in Hawaii which has had a mask mandate for months now, and the way regular people are actually handling their masks in the real world is very, very far from the way trained medical professionals handle their masks.

microtherion 6y ago
> Average age of the covid-19 dead in Sweden is 82, average life expectancy is 83. That's life expectancy at BIRTH. It would seem to me that the relevant statistic in the case of an 80 year old dying is the average life expectancy they had at 80, which is considerably more than 3 years.
- henrikschroder 6y ago
  You're right, but it's actually even more specific than that, you have to look at the life expectancy of a frail 80-year old living at an elder care facility suffering from diabetes/hypertension/heart problems. Not that of a random, healthy, 80-year old. The biggest disingeniousness of the people talking about the covid-19 specific death toll is that the assumption is that if not for covid-19, everyone would have lived forever and ever, and that's simply not true. Looking at the demographics of the dead, for many, covid-19 is what happened to push them over. If not for covid-19, something else would have done it in a similar timeframe, especially since the flu seasons of 2018/19 and 2019/20 were so mild. Yes, there are people who died significantly before their time, but they're a small minority of the dead. So 10 QALY lost per dead is way too much. 1 QALY lost per dead is too little, I agree. The truth is probably somewhere in between.