ISSUE: To debate alternatives to the common cost per QALY threshold approach to determining whether a new intervention should be funded. OVERVIEW: In most countries, the majority of physicians and patients do not have unfettered access to all the interventions that can help diagnose, treat or prevent illness. Even if these have been shown to be effective and reasonably safe, their costs may be judged too high to allow unrestricted use. When appraising the balance between benefits and costs, a common, though not universal, tactic is to compute the ratio of net costs to net health effects and then weigh this ratio against a “threshold”. In the face of growing concerns that this method does not sufficiently capture what society wants, new approaches are urgently needed. This panel will address this challenging topic from widely divergent perspectives with a view to fostering discussion of the challenges and potential alternatives.