OBJECTIVES: The National Centre for Pharmacoeconomics (NCPE) appraises the cost-effectiveness of new and existing technologies (medicines, diagnostics and devices) which may entail a high budget impact to the health system, in response to requests from the Health Service Executive (HSE). In the case of new medicines, assessments may be conducted prior to reimbursement application but must be completed within 90 days.  We describe the pharmacoeconomic evaluation process in Ireland and provide examples of recent appraisals and the subsequent impact on pricing and reimbursement decisions. METHODS: The pharmacoeconomic appraisals conducted by the NCPE between September 2006 and May 2009 were reviewed. The NCPE recommendations and subsequent reimbursement decisions by the HSE were recorded. The duration of the pharmacoeconomic process and the time from marketing authorisation to reimbursement was estimated. The budget impact assessments from the pharmaceutical companies were reviewed and compared for consistency. RESULTS: The NCPE conducted fourteen single technology appraisals during the study period. There is only one example of an existing medicine where cost-effectiveness data was requested to ensure continued reimbursement. All other evaluations were for newly licensed medicines. Eight of the medicines assessed were either recommended as a cost-effective use of resources or recommended with certain restrictions, and were funded by the HSE. Of the six medicines that were not considered cost-effective, two were reimbursed after a price reduction was negotiated, two were not reimbursed and the decision for the remaining two medicines is pending. The average duration of the pharmacoeconomic process was 2.7 months. The average time from marketing authorisation to reimbursement was 7 months. The review of budget impact assessments highlighted a high degree of variability between submissions. CONCLUSIONS: The findings of this review demonstrate the efficiency of the pharmacoeconomic process and the acceptance of the NCPE recommendations by the HSE for pricing and reimbursement decisions.