Although geographic variations do exist, health care decision-making regarding the adoption and
reimbursement of technologies has traditional been based on four main criteria. These criteria are
identified in a literature review [32] comparing the selection processes of reimbursable drugs in public
drug benefit plans across high- , middle- and low-income countries. These criteria are safety, efficacy,
value for money (cost-effectiveness) and budgetary impact (affordability). Many see these criteria as
hurdles, where new technologies must be proven first to be safe, then effective, then cost-effective and
then finally affordable.