We thank the authors for their comments, because it offers the opportunity for an ardent discussion. Value-based healthcare (VBHC) has remained at a different level of operation from cost-effectiveness analysis (CEA) since its introduction. As a consequence, VBHC’s central concept has remained an abstract ideal rather than a stimulating performance standard, which is interesting, considering that it promotes a rigorous, disciplined measurement of value as the best way of driving system progress.