Economic evaluations of healthcare interventions routinely focus on population level cost-effectiveness analyses to support reimbursement decisions; the so-called ‘Fourth Hurdle’. Yet what is informative at the policy level does not always translate meaningfully to the local population or individual patient level. Population level analyses consider the ‘average patient’, while local payers and prescribers work with a group of individual patients with specific characteristics and health challenges. Translating the findings of policy level analyses to individual patients requires a full understanding of drivers of economic value and consequent affordability. Demonstrating value to payers and prescribers is increasingly recognised as the ‘Fifth Hurdle’.