The clinical and economic value of a successful shutdown during the SARS-CoV-2 pandemic in Germany.

Background and aim: A shutdown of businesses enacted during the SARS-CoV-2 pandemic can serve different goals, e.g., preventing the intensive care unit (ICU) capacity from being overwhelmed ('flattening the curve') or keeping the reproduction number substantially below one ('squashing the curve'). The aim of this study was to determine the clinical and economic value of a shutdown that is successful in 'flattening' or 'squashing the curve' in Germany. Methods: In the base case, the study compared a successful shutdown to a worst-case scenario with no ICU capacity left to treat COVID-19 patients. To this end, a decision model was developed using, e.g., information on age-specific fatality rates, ICU outcomes, and the herd protection threshold. The value of an additional life year was borrowed from new, innovative oncological drugs, as cancer reflects a condition with a similar morbidity and mortality burden in the general population in the short term as COVID-19. Results: A shutdown that is successful in 'flattening the curve' is projected to yield an average health gain between 0.01 and 0.05 life years (0.1 to 0.6 months) per capita in the German population. The corresponding economic value ranges between €616 and €4797 per capita or, extrapolated to the total population, 1%-12% of the gross domestic product (GDP) in 2019. A shutdown that is successful in 'squashing the curve' is expected to yield a minimum health gain of 0.08 life years (1 month) per capita, corresponding to 19 % of the GDP in 2019. Results are particularly sensitive to mortality data and the prevalence of undetected cases. Conclusion: A successful shutdown is forecasted to yield a considerable gain in life years in the German population. Nevertheless, questions around the affordability and underfunding of other parts of the healthcare system emerge.