The choice of perspective is important in the economic evaluation of healthcare interventions. For example, in the National Institute for Health and Clinical Excellence’s (NICE) technology appraisal of drugs for Alzheimer’s disease, a major discussion point was whether the costs falling on caregivers should be included as well as costs to the NHS.1

The main argument for adopting a restrictive perspective is that the budget for the NHS is meant to be for improving health. Therefore, the relevant consideration in evaluating interventions is the opportunity cost (in other treatments forgone) on the healthcare budget. But alternatively shouldn’t the full social benefits of healthcare interventions be considered? If healthcare interventions have benefits outside the healthcare sector—for example in the criminal justice system, transport sector, or education—shouldn’t these be tracked and any budgetary adjustments sorted out separately? And shouldn’t health care aim to provide benefits to families and carers as well as the patient?

Textbooks say …