The National Institute for Health and Clinical Excellence (NICE) in the UK makes decisions about health technologies based on evidence and cost-effectiveness. A new study looked at how NICE makes these decisions and found that having more clinical evidence makes it more likely for a technology to be recommended for routine use. Higher cost-effectiveness ratios make it more likely for a technology to be rejected. The type of technology, when it was appraised, and patient group submissions also play a role in NICE decisions. This study suggests that NICE decisions are more accurately represented as a choice between three categories rather than just accept or reject.