COVID goes Cuckoo

The COVID care response in the Netherlands has led to a gain of 13-21 thousand healthy life years, our new study entitled ‘COVID goes Cuckoo’ shows. However, the gain in healthy life years is low relative to its cost: an estimated 100-400 thousand healthy life years have been lost by cancelling or postponing regular care, such as for cancer, heart disease or diabetes. The financial burden is equally disproportional: the costs per gained healthy life year amount to EUR100-250 thousand, well above typically applied cost-effectiveness norms.

The COVID care response in the Netherlands has led to a gain of 13-21 thousand healthy life years. However, this gain has come at an unacceptable loss in REGULAR care. As COVID care overwhelmed the hospital system, REGULAR care appears to be the unintended victim with disproportional ‘collateral damage’. The loss of healthy life years due to the reduction in REGULAR care resulting from the COVID epidemic is estimated to be 100 to 400 thousand in the Netherlands. REGULAR care loss is thus an order of magnitude larger when compared to both the number of healthy life years gained with COVID care and the 10-15 thousand healthy life years lost from COVID.

The financial burden of COVID is equally disproportional. Direct costs of COVID care are EUR 7-23 thousand per healthy life year gained. At the same time COVID has driven up REGULAR hospital unit costs by 40%. Accounting for this effect, the ‘true’ cost of COVID care per healthy life year gained is estimated to be EUR 100-250 thousand. This is higher, potentially several folds so, than the current upper cost-effectiveness reference norm of EUR 80 thousand used by Dutch authorities. Considering the current and unprecedented economic downturn these costs are even more untenable.

This COVID epidemic is likely to have a protracted course. The way we delivered COVID care so far is unsustainable. Given the size of the problem (order of magnitude higher costs and order of magnitude loss of healthy life years in REGULAR care) and the uncertainty surrounding even the near-term future, it is imperative to thoroughly explore and implement efficient and efficacious solutions.

We should use this period of relative calm to design and implement a well thought out action plan to deliver both COVID and REGULAR care. Such a plan must consider fully novel and hitherto ‘unpalatable’ choices, like fully specialized and centralized COVID facilities, centralized hospital capacity management, triage of REGULAR care based on efficacy and efficiency, accelerated adoption of alternative delivery models (like outreach, telemedicine and home care), or, perhaps, an acceptance of structurally higher per-unit cost of delivery for the foreseeable future.

In our next study, we will estimate the potential impact of the various policy options.

Download the full report "COVID goed Cuckoo" here »

In the media

De andere rekening van de coronazorg

Lees hier een artikel in de volkskrant over deze studie

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Gruwelijke maar nuttige rekensommen

Lees hier een column van Bert Wagendorp over deze studie

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