OBJECTIVES: To explore how patients and payers perceive value and risk and investigate the role of patient-reported outcomes. METHODS: Quintiles surveyed a variety of US and UK stakeholders including: an online survey of payers (US managed care, UK National Health Service) and a telephone survey of adult patients being treated for a chronic disease.  RESULTS: Between January and March 2012, 144 payers (75 US, 72 UK National) and 1009 patients (509 US and 500 UK) were surveyed.  In general, payers were more optimistic that the quality of healthcare would be improved 10 years from now than patients (68% US / 66% UK payers vs. 49% US / 38% UK patients).  From the payer perspective, over 80% of payers support use of risk sharing for: 1) population-based performance guarantees (i.e., coverage dependent on meeting a benefit target) and 2) Coverage with Evidence Development (CED) deals (i.e., future review based on real-world product evidence). High administration costs (66%), difficulties in agreeing on definition of success (67%), and difficulties in accurately measuring treatment success (63%) are among main problems.  With 77% of US and 73% UK payers supporting the shift to a more patient-oriented approach to treatment assessment, it is not surprising that PROs are the metric most commonly used to assess risk/benefit (60% and 71% respectively). Patients are in agreement with payers that PROs are most important in how they evaluate the value of medicines (51% US, 60% UK).  Other important drivers of patient value: helping people live longer (14% US, 24% UK) and affordability (25% US, 2% UK). CONCLUSIONS: Payers and patients agree that use of PRO data is critical to assessing value and benefit-risk for prescription medicines.  The shift to patient-centered treatment assessments and growth in risk sharing assessments will further increase the need for real-world PRO data.