analysis. It should be noted, however, that because of different budget responsibilities (i.e. budget
silos), that even though a treatment may be cost saving from a societal perspective overall, some of the
cost savings (or cost offsets) may benefit different ‘payers’ in a health care system, and as such a
dominant treatment may still be considered unaffordable to a particular funding agency. For example,
this typical occurs with the assessment of new drugs, where the drug results in additional costs to drug
program branch and the cost savings (e.g. reduced doctor visits or hospitalizations) are realized by a
different budgetary ‘silo’ of the government.