The National Institute for Health and Clinical Excellence (NICE) is a decision-maker. Where NICE reaches a positive conclusion about the use of a particular health technology (such as a pharmaceutical product) in the National Health Service (NHS), there is a legal requirement for the service to make it available if a patient’s physician considers it clinically appropriate [1]. Although this legal obligation does not apply to technologies recommended in NICE’s clinical guidelines, there is still a reasonable expectation by the Care Quality Commission for NHS healthcare professionals to use NICE’s clinical guidelines as the basis, where appropriate, for their clinical practice.

NICE’s independent advisory bodies (the Appraisal Committees, the Public Health Advisory Committee and Guideline Development Groups) are required to take account of both clinical and cost-effectiveness in reaching their conclusions about the use of health technologies generally and of pharmaceuticals in particular [2–4]. These advisory bodies must fully assess the available evidence on benefits and costs in order to come to a decision as to whether the use of a technology is considered a costeffective use of resources.