This research examines the use of QALY thresholds in NHS Scotland in 2012-13 for health services that were “at the margin”, i.e. those for which investment or disinvestment was planned or occurred.

The study was based on information from three sources: public information from the Scottish Parliament’s examination of the NHS Boards’ expenditure plans, interviews with the Finance Directors of Scotland’s territorial NHS Boards, and a literature review.

The NHS Board interviews revealed a considerable and varied list of health care services and technologies at the margin of NHS spending in one or more of the 14 NHS board areas in Scotland. The literature review discovered that the available cost-per-QALY evidence would be a poor guide to decision making. However, the interviews suggested that cost-per-QALY evidence is not generally taken into account in NHS Board expenditure decisions about marginal services.

The apparent mismatch between the approaches of the NHS Boards and the SMC present important policy questions about whether and how these might be realigned.

A revised version of this paper has been published in Health Policy and can be downloaded from:

Please cite as: Karlsberg Schaffer, S., Sussex, J., Devlin, N. and Walker, A., 2015. Local health care expenditure plans and their opportunity costs. Health Policy, 119(9), pp.1237-1244.