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The conclusion from Huseyin Naci and colleagues1 that more quality-adjusted life-years (QALYs) would have been gained if funding for new drugs was allocated elsewhere crucially relies on an opportunity cost estimate of £15 000 per QALY.1 A key question, however, is how should the funding have been allocated? Medicines make up less than 12% of National Health Service spending2 and most expenditure—more than £70 billion—is on salaries.
