By David Hunter

James Wilson (UCL) and I recently wrote a briefing paper for the Nuffield Council on Bioethics on the ethical issues surrounding hyper-expensive treatments – that is treatments which exceed NICEs usual cut off point of £30000 per quality adjusted life year (qualy). One factor that we kept coming back to was the need to consider the opportunity cost of funding relatively inefficient medicines (which has implications for example for Cameron’s Cancer Drug Fund).

I thought it was apt today to reflect on the opportunity costs involved in the tax payer footing the bill for part of the royal wedding – namely the security costs. These have been estimated now at twenty million pounds.

Hence if this public expenditure was instead used on health care, using NICEs cut off point we could at least save 666 quality adjusted life years – and of course it could be much more since many treatments cost less than £30000 per qualy.

Now of course things aren’t this clear cut, we have to factor in the probable tourist income due to the wedding, the tax income from people buying bunting and flags from the pound store and so on as well as the impact of all the good will and cheer the papers are nattering on about. And to counter balance this we need to consider any further tax earnings from the 666 Qualys generated, the economic costs of an additional public holiday and so on.

Nonetheless it is at least a sobering thought – there may well have been a public good based argument for the royal couple eloping…