OBJECTIVES: In Korea, the Positive List System was adopted in the end of 2006 and the cost-effectiveness had been important in decision making process for reimbursement. We tried to check the appraisal results. METHODS: Total of 5-years decision-making from 2007 to 2011 were reviewed and classified in several categories according to relative effectiveness and submission type of cost-effectiveness. RESULTS: Among 219 results which were made decision there were 149 recommendations(68%) for listing. 50 submissions were cost-effectiveness(utility) analysis report but 26 submissions of those were improved relative effectiveness compared to the comparator. 24 drugs were submitted CEA or CUA even though they didn’t have evidence for improvement. If there was no evidence for the relative effectiveness or the new drug was inferior HIRA decided not to list. If new drug had evidence for non-inferiority it could be evaluated by cost-minimization analysis. 11 drugs were decided to be listed among 12 submissions by CMA. There were 9 essential drugs to be appraised for 5 years. CONCLUSIONS: The most important factor in decision-making for reimbursement was relative effectiveness and the method of economic evaluation was determined by drug’s relative effectiveness. In deciding acceptability in cost-effectiveness results the other factors are considered whether the drug used in severe disease or it was orphan drug, etc.