OBJECTIVES: How healthcare decision makers arrange their appraisal process of new healthcare technologies have direct impact on population health. However, no consensus exists on how the appraisal process should be designed to maximise population health or societal welfare. The purpose of this work is to develop a simple analytic framework that enables analysis of the different stakeholders’ (decision makers and manufacturers) payoffs from alternative appraisal processes. METHODS: The analytic framework outlined in the paper is based on viewing the appraisal processes as a diagnostic test aimed at identifying cost-effective (true positives) and cost-ineffective (true negative) technologies. Based on this characterisation pay-off functions are formalised to analyse how design and operation of the appraisal process impacts population health and manufacturers’ earnings. RESULTS: The framework identifies those factors that have the greatest influence on population health and manufactures payoffs and illustrates how this leads to conflicting interests towards how the appraisal process should be set up and operated. It is demonstrated that there is no uniquely optimal way to design and operate the appraisal of new healthcare technologies, since optimal design and operation depends on the price of technologies that undergo appraisal. The analysis also shows that operating a given reimbursement system implies a trade-off between incentivising cost-effective pricing (pricing below the threshold/willingness to pay) and rejecting more cost-effective technologies (increasing the proportion of false negatives). It is further demonstrated how the framework can be used to gain insight into current policy questions including who should bear the burden of proof and how rigorous the process should be. CONCLUSIONS: There is no unique way to design and operate the appraisal of healthcare technologies in order to maximise population health or societal welfare. Improving health or societal welfare through the appraisal process requires careful consideration of payoffs and incentives of all stakeholders.