Editorial Promoting economic value in public health

In the pharmaceutical field, the term ‘fourth hurdle ’ hasbecome common currency in many health systems. It means that only products that can show their cost-effectiveness will gain unrestricted access to patients. The preceding hurdles of safety, efficacy and quality have existed for several decades and have been harmonized within the European Union years ago. In the early 1990s, Australia and Canada pioneered the integration of cost-effectiveness into the regulation of drug reimbursement; by 2005, a survey identified 10 more European countries to consider this aspect in drug regulation.1 Adding France and Germany leads to at least a dozen European countries going this way today. The emphasis of the ‘fourth hurdle ’ is on individual clinical care. ‘Concentrating on drugs and clinical procedures does not really have a great influence on population health’2 Holland criticized after having reviewed the first experience of healt