There are several factors that influence whether patients with a clinical complete response in rectal cancer are managed by watch-and-wait . These include patient-related (including their preferences), health professional-related, and policy maker-related. Here, we specifically addressed the latter using value based assessment frameworks (VBAFs). Value based assessment frameworks (VBAFs) are a structured set of methods and/or processes developed to assess the value of healthcare interventions when used in healthcare systems. The goal of the VBAFs is to show a structured approach to identify, quantify and value interventions in terms of benefits and harms and in some situations consideration of opportunity cost.