Does the world need another book on cost-effectiveness analysis (CEA) in health care? It already has a number of excellent ones, including widely read how-to manuals (Drummond et al., 1997), a popular “bible” on the topic by the U.S. Panel on Cost-Effectiveness in Health and Medicine (Gold et al., 1996), and numerous volumes that address theoretical and methodological issues and advances (e.g., Johannesson, 1996; Nord, 1999; Pettiti, 2000; Drummond and McGuire, 2001). Furthermore, does anyone in the United States really use cost-effectiveness analysis? The question has been posed frequently, even (or especially) by analysts themselves but then left hanging, shrugged off like a remark about the weather or the latest impasse in the Middle East. Despite its promise and the steady stream of analyses conducted and published, policy makers in the United States have shied away from using CEA openly. This experience contrasts markedly with the flourishing application of CEA to coverage and reimbursement decisions abroad. Why? The usual explanation—that Americans are different, that we are rugged individualists who will not accept explicit rationing—seems too convenient and too simplistic, and anyway not at all helpful. Why are CEAs being published widely in mainstream American medical journals if the technique is hopelessly ineffectual? Are there examples in which American policy makers have successfully applied the approach? What can we learn from them? CEA offers a powerful tool to help prioritize resources for health care more efficiently. As health spending in the United States soars past $1.5 trillion, CEA lies at the heart of perhaps the ultimate health policy question: how can we get good value for our money?