“…Efficiency considerations often fall by the wayside and are trumped by evidence of clinical benefit, political and/or other considerations (Martin et al, ; Eddama and Coast, ; Boon et al, ; Armstrong et al, ). There is no agreement on what these decision criteria should be, how important they should be relatively to one another, nor is there a common framework for how they should be used in combination (Chabot and Rocci, ; Boon et al, ; Franken et al, ; McDonald et al, ; Franken et al, ; Cleemput et al, ; Drummond, ; Franken et al, ). There is also a lack of guidance to the interpretation of evidence, including PE (Wranik, ; Franken et al, ).…”