What will it take to make cost-effectiveness analysis acceptable in the United States?

Many believe cost-effectiveness analysis (CEA) to be an underused tool to assist healthcare decision-makers. Reasons given for its underuse have largely focused on unstandardized methods, potential for bias, lack of training particularly among potential consumers of studies, and lack of trust between sponsors and users of analyses. This commentary reflects on these and related issues, including legal and political constraints. It discounts many of the conventional arguments regarding the real obstacles to using CEA and suggests steps needed to make CEA more acceptable to US healthcare decision-makers.