EDITOR, - Felix Bochner and colleagues make a useful contribution to the database related to drug utilisation review and pharmacoeconomic outcomes.1 We write to comment on the philosophical position and strategic and operational assumptions in their paper. We believe that budgets can be contained by a process other than rationing by prioritisation, and we present our experience at the Alfred Hospital, Melbourne, to support our assertions. We also comment on the management fallacy inherent in assigning arbitrary budgetary targets for use of pharmaceuticals.

The table shows the raw year on year (June) budgetary data for the hospital over the past six …