Perspective and desire in comparative effectiveness research: the relative unimportance of mere preferences, the central importance of context.

Economists engaged in comparative effectiveness research (CER) commonly adopt particular value judgements that underpin many of their methods. Two of these are the idea of a 'societal perspective' and that the foundation of values in measures of health outcome is individual preferences. This article takes issue with both value judgements and argues instead that the values to be adopted are not ones to be determined a priori or independently of the context of the analysis. Indeed, the first task of analysts is to discover these values by early and ongoing consultation with the commissioners of the CER. The same arguments apply to the practice of cost-effectiveness analysis.