OBJECTIVES: Due to increasing budgetary pressures and a rising demand for technology appraisals, from April 2019 NICE will start charging a standard fee of £126,000 (~$162,000) for appraising pharmaceutical products. NICE already charges manufacturers for some of their services, e.g. Scientific Advice, which can cost up to £50,000 (~$64,000). The UK also has a scheme for capping the price growth rate of branded products to 2% in the latest Scheme for Branded Medicines Pricing and Access (PPRS-2019). This research evaluates whether NICE’s services are cost-effective by comparing their respective fees with other European HTA bodies. METHODS: We assessed charges for appraisals and Scientific Advice in 27 European Union member states. RESULTS: NICE is the first HTA body within EU5 to charge for appraisals, with only Latvia, Poland, Hungary, Spain and Czech Republic charging within the broader EU. NICE is also the costliest agency for seeking scientific advice within EU5 (up to ~$64,000) vs. AIFA (Italy) up to €40,000 (~$46,000), G-BA (Germany) up to €10,000 (~$11,500), AEMPS (Spain) up to ~€4,500 (~$5,200) and HAS advice being free. The combined cost of seeking advice and reimbursement in England could reach up to £200,000 (~$257,000). Given that 1 in 5 NICE appraisals result in a negative recommendation and assuming that 75 pharmaceutical products are due to be appraised in 2018/19, this could result in the pharmaceutical industry spending up to £3 million (~£3.9 million) a year on failed reimbursement applications. CONCLUSION: England will now have the highest cost of seeking both reimbursement and early advice in Europe, being substantially higher than much larger pharmaceutical markets. Already, c10% of STAs are terminated due to manufacturer non-submissions. These new charges pose an additional deterrent to companies seeking market access in England, especially in the context of the UK’s imminent exit from the EU.