OBJECTIVES: Cost-effectiveness analysis of health technologies typically involves the calculation of incremental cost-effectiveness ratios (ICERs). In some jurisdictions, decision makers compare these ICERs to an explicit cost-effectiveness “threshold” as part of their deliberations. The use of a threshold remains controversial and there is disagreement over what such a threshold, if adopted, should represent. Furthermore, there are many issues and limitations with the interpretation of ICERs. This paper argues that the needs of decision makers and patients would be better served by abandoning ICERs and thresholds altogether and adopting instead a decision framework based upon a modified notion of “net benefit”. METHODS: Using recent Ontario-based cost-effectiveness analyses as examples, we demonstrate that the traditional interpretation of ICERs can be misleading. We also demonstrate why comparing ICERs to an explicit threshold cannot satisfy the needs of decision makers or patients – regardless of the threshold used – except under very specific circumstances. We then show how the traditional “net benefit” approach to decision making may be modified to incorporate concerns for efficiency, equity, societal and ethical values, and patient preferences. CONCLUSIONS: Abandoning ICERs and thresholds and adopting a decision framework based upon a modified notion of “net benefit” would not only address many of the issues with ICERs and thresholds but would be easier for decision makers to interpret. It would also allow decision makers who adopt multiple decision making criteria (such as concerns for efficiency, equity, societal and ethical values, and patient preferences) to make explicit trade offs between these criteria.