Covid, lockdown and the economics of valuing lives

How much should we pay to save life? The question is often viewed as distasteful: you can’t put a price on human life. But resources are finite. Even if the only purpose of life was to prolong it for as long as possible, there would be limits to healthcare affordability. So if resources are limited, how can their application be made fairly? And how can this logic be applied in a pandemic?

One element when establishing a fair method is to consider life years saved rather than lives saved. This recognises that someone of my age (55), who has already enjoyed two-thirds of his likely life span, should be a lower priority for treatment than a child who has had barely a tenth of theirs. A vampire society might sacrifice the young to prolong the lives of the old, but most of us would reject this, whatever our age. Counting life years also acknowledges that life-saving is always temporary; that medicine is really about prolonging life.

Every government has a way of deciding when a life-saving intervention is too expensive. The UK has the National Institute for Health and Care Excellence, which considers the life years saved (quality adjusted, but we can neglect that here) when approving NHS treatments. Broadly speaking, Nice approves interventions if the ‘cost per life year saved’ is below £20,000 to £30,000. This consistent approach is a second element of fairness. If, for example, treatment were allowed that cost £40,000 per life year saved for one person while denying two others treatment that cost £20,000 per life year, then that would effectively be buying life for one person by denying it to two others.