Objective: The British Parliament recently held an inquiry into the National Institute for Health and Clinical Excellence (NICE) health technology appraisal (HTA) process. We summarized stakeholder concerns about health economic and decision methodology used for HTAs appraisals and funding decisions, particularly with regard to serious/life-threatening illnesses, and drew comparisons to standards among other nations that use HTA to understand why criticisms might have arisen. Methods: A systematic review was conducted of written evidence submitted to Parliament about the appraisal process and corresponding health economic methods. Stakeholders were limited to manufacturers, professional and trade associations, and patient/disease advocacy organizations (limited to oncology). We excluded evidence from individuals. We extracted themes from this evidence and generated items for a comparison of methods of other countries that conduct appraisals. Only publicly available, English-language qualitative data were considered. Results: We identified written evidence from 92 constituents through August 1, 2007, of which evidence from 27 were extracted using our criteria. Stakeholder comments on the HTA process and decision methodology were distilled into 12 categories, ranging from impact of severity/rarity of disease on acceptability of cost-effectiveness thresholds to over-reliance of QALYs in decision-making. Compared to attributes reported for other countries, NICE's criteria and methods for health economic assessment and decision-making varied substantially, such as that of the model perspective, e.g., payer versus societal. Conclusion: We found that aspects of NICE technology appraisals garner criticism common to many stakeholders. This underscores the need to reconsider how current health economic and decision methodology might be improved. Furthermore, country-level heterogeneity in HTA processes and methods suggests the need to determine why these variations arise, and whether they reflect societal preferences or misunderstandings of appropriate methods.