An aging population, technological advances, and societal attitudes regarding what health care can and should be delivered to all members of society have produced rapidly rising health care costs. As a consequence, there is a major global trend toward more stringent assessment of the costs and benefits of treatments produced by the pharmaceutical and medical device industries. The focus on value is almost complete in markets dominated by government-provided health care, but even in markets where private insurers cover a significant amount of care, rising premiums and increased deductibles exert mounting pressure on the entire system to produce economic and clinical value, not just great care.

Rapidly rising costs have been a major concern in the United States for decades, resulting in several attempts to emphasize value over pure clinical efficacy. These can be traced back to the birth and growth of HMOs, even the name of which (“Health Maintenance Organizations”) pointed toward the concern with value — “we won’t just treat ill health, we’ll prevent it”, which is generally agreed to be the more cost-effective approach.