OBJECTIVES: The FDA's approval of Avastin, Erbitux and other novel agents has generated debate about the high cost and relative value of new cancer treatments. We sought to understand whether oncologists consider the therapies they employ to be cost-effective and to ascertain oncologists' cost-effectiveness thresholds for such therapies. METHODS: We surveyed 139 oncologists at two large academic hospitals in Boston. We asked respondents to provide estimates for the cost and effectiveness of Avastin (without appealing to published data) and whether they thought the treatment offered “good value.” We also asked respondents to judge how large a gain in life-expectancy would justify a hypothetical new cancer therapeutic that cost $70,000 per year more than standard care. We used this information to calculate implied cost-effectiveness thresholds (in QALYs) for each respondent. Finally, we asked respondents about the role of cost in their treatment recommendations. RESULTS: Ninety oncologists (65%) completed the survey. Cost-effectiveness thresholds, derived from the hypothetical scenario, averaged over $300,000/QALY. Oncologists' estimates of the cost and survival benefit of Avastin implied a cost-effectiveness ratio in the same range, yet only 25% of oncologists believed Avastin offered good value. Oncologists who indicated a greater sensitivity to costs in their prescribing behavior had significantly lower cost-effectiveness thresholds. CONCLUSIONS: Oncologists in an academic medical setting had implied cost-effectiveness thresholds that were roughly 6 times higher than a commonly cited standard in the U.S. of $50,000/QALY. When asked about specific scenarios, however, oncologists implied that very small gains in life expectancy were not worth the additional costs. Further, most oncologists were dubious about whether a recently approved therapy offered “good value.” As expensive new cancer therapies enter clinical practice, oncologists' views about their role as practitioners may increasingly conflict with their beliefs about the value offered by these therapies.