Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 1 2018 01 01 The Bright Elusive Butterfly of Value in Health Technology Development; Comment on “Providing Value to New Health Technology: The Early Contribution of Entrepreneurs, Investors, and Regulatory Agencies” 81 85 3372 10.15171/ijhpm.2017.65 EN Trisha Greenhalgh Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK 0000-0003-2369-8088 Nick Fahy Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK Sara Shaw Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK 0000-0002-7014-4793 Journal Article 2017 03 26 The current system of health technology development is characterised by multiple misalignments. The “supply” side (innovation policy-makers, entrepreneurs, investors) and the “demand” side (health policy-makers, regulators, health technology assessment, purchasers) operate under different – and conflicting – logics. The system is less a “pathway” than an unstable ecosystem of multiple interacting sub-systems. “Value” means different things to each of the numerous actors involved. Supply-side dynamics are built on fictions; regulatory checks and balances are designed to assure quality, safety and efficacy, not to ensure that technologies entering the market are either desirable or cost-effective. Assessment of comparative and cost-effectiveness usually comes too late in the process to shape an innovation’s development. <br />  <br />We offer no simple solutions to these problems, but in the spirit of commencing a much-needed public debate, we suggest some tentative ways forward. First, universities and public research funders should play a more proactive role in shaping the system. Second, the role of industry in forging long-term strategic partnerships for public benefit should be acknowledged (though not uncritically). Third, models of “responsible innovation” and public input to research priority-setting should be explored. Finally, the evidence base on how best to govern inter-sectoral health research partnerships should be developed and applied. https://www.ijhpm.com/article_3372_37d0b499fb84a552c17fcbb1442d7895.pdf