Hi,

Very interesting discussion, please continue! Although I'm very
time-limited nowadays (strange when I barely leave the house any
more).

I think on a similar topic:

Thomas, P., 2020, "J-value assessment of how best to combat Covid-19", Paper for Nanotechnology Perceptions.
http://jvalue.co.uk/covid-19.php

Quite mathematical so many of you will probably like it more than
me. BIG question indeed is about appropriateness of lockdown continuing
indefinitely - how many people did Austerity already kill? The recession
of the next five years following this will be worse...

Some of us have already started thinking about this issue and trying to
get info together.

Best wishes,

     -- Andrei
     
On Sat, Mar 28, 2020 at 02:56:54PM +0000, Kevin.Mcconway wrote:
> A bit more, some stemming from an off list exchange that John and I had earlier. If anyone would rather I shut up, please say.
> 
> John asked whether I know of a better methodology for looking at this sort of question. If there is, I don’t know of it, but just because I don’t know personally of a better methodology, that doesn’t mean that this kind of cost-benefit methodology should be used.
> 
> So should people be trying to do this? That is, somehow to ask the question of whether the mitigation and suppression measures (like lockdowns) are “worth it”, or whether they should not happen or be replaced by something less extreme. I think it is difficult to answer whether people should be trying to do it. Whether we could get any good rational discussion of this kind of thing at this kind of time is another question. I suspect not.
> 
> I think it probably is a question that should be asked, but to a large extent I think that because I think it shows up the limitations of this kind of cost-benefit (or whatever one calls it) analysis. It also demonstrates that this sort of rationing, decisions on trade-offs, and so on go on all the time, sometimes openly and in terms with stated policies and guidance from NICE etc., sometime implicitly. (Not necessarily deliberately hidden, just done intuitively, or on precedent, or whatever.)
> 
> One issue that it throws up is how to deal with decisions that lead to, or avoid, bad effects on a large number of individuals at once. If the loss of QALYs is the same in both cases, is it worse that 50,000 people die over a very short period of time, or if 5,000 people a year die over 10 years? The former is perceived to be worse, but should it be dealt with as worse? I think here there’s a risk of confusion with the (probably nonlinear) effects on the economy of big losses of life.
> 
> And there is also a relationship to a question that’s been endlessly discussed (and relates to something John put in his message earlier), though this is probably an utter nitpick in the current context – in working with DALYs (or QALYs or similar), should there be age weighting, and should there be discounting (so that a death or disability that occurs in a year’s time should be downweighted in comparison with one that occurs now)? When WHO ran the Global Burden of Disease (GBD) project, up to 2004 anyway, their principal figures included discounting (3% per year) and, in some years, age weighting too (the value of a DALY went up from birth to age 22 and then down after that – there’s a graph of the function they used in the Wikipedia article on DALYs, which shows e.g. that a DALY at age 22 was worth over twice as much as a DALY at age 70). But at some point, possibly at the same time as GBD moved over to IHME, they stopped using discounting and age weighting.
> 
> OK, enough already. I’m not sure this is helping.
> 
> Best wishes,
> Kevin
> 
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-- 
Andrei Morgan MRCPCH, MSc, PhD (Epidemiology / Neonatology)
https://www.andreimorgan.net

Honorary Clinical Lecturer,
Department of Neonatology,
Institute for Women's Health,
University College London


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