U.S. spending for cancer is increasing rapidly, because of the aging society, greater use of screening services, and new treatments that come with very high price tags. In this Perspective I argue that projections of the impact of medical innovation on health care budgets are not only difficult but ultimately meaningless. Rather than focusing on cost, the research and policy communities should consider a value-based approach towards developing and adopting cancer therapies, whereby innovations in cancer are viewed by gains in survival and reduced morbidity relative to their price.