At a time of tension between vigorous innovation and increasing costs in health care, health care decision makers require comprehensive evidence of the value of new drugs, devices, procedures, and biologics.  Policy makers and proponents of health care system reform thus routinely argue that simultaneously meeting the goals of sustained innovation, cost control, and improved quality within the health care system will require more explicit appraisal of the clinical effectiveness and comparative value of new and existing interventions. The Institute for Clinical and Economic Review (ICER) was created to fill this evidence gap.