OBJECTIVES: Determine the impact of new end of life criteria on reimbursement decisions of cancer drugs appraised by NICE. METHODS: Review of Single and Multiple Technology Assessments on cancer treatments appraised by NICE from January 2009 to April 2011. RESULTS: NICE appraised 30 cancer treatments. 16 were recommended with restrictions and 13 were not recommended. The reason for not recommending was poor cost effectiveness (7) and lack of evidence (6). The Committee considered the impact of giving a greater weight to QALYs achieved in the later stages of terminal diseases in nine of the positive recommended drugs. End of life criteria were considered when the most plausible ICERs fall above the threshold normally considered as cost-effective. End of life criteria were not taken into account when the appraised drugs had ICERS below £30,000 per QALY gained (6 cases) or when it resulted in cost saving for the NHS. When ICERs estimates exceeded what NICE considers a reasonable use of NHS resources for the whole population covered by the marketing authorisation the Committee discussed whether the magnitude of weight required for the ICER to be in a cost effective range was acceptable in special subgroups of population. CONCLUSIONS: The discussion of end of life criteria was straight forward when the new drug provided a marked change in the treatment of the disease or its high price was compensated by a patient access scheme agreement. On contrary, it was more difficult to decide whether survival benefits offered the extension of life required in order the supplementary advice to be considered.  The supplementary advice facilitated the appraisal process of cancer drugs however the Committee had to make judgments to interpret the incomplete evidence in order to decide what is good for patients and who can benefit from new cancer treatments.