Cost-effectiveness analysis plays a limited role in US health care compared to many other countries. In this Seminar Briefing, Dr James Chambers, Center for the Evaluation of Value and Risk in Health at Tufts Medical Center, considers the current use of cost-effectiveness analysis in the US and explores the potential value of including it in decisions about coverage for medical technology by Medicare (the national public health insurance programme primarily for people 65+ years of age). He reviews the current barriers in the US – both legislative and otherwise – to wider adoption of cost-effectiveness as a basis for health care decisions and notes attempts to use payment reform instead to increase incentives for greater efficiency.