The research reported in this issue by James Lomas1 makes a useful contribution to a vexing question: how to consider new technology investments (quintessentially, hepatitis C treatments) that are acceptable by usual cost-effectiveness analysis (CEA) standards but fracture budgets of healthcare-providing organizations such as the British National Health Service (BNHS) that operate with externally imposed budget constraints. This commentary extends that discussion about opportunity cost and healthcare, moving from the “within budget” opportunity cost to the wider question of socially optimal balancing of medical spending versus other consumption.