Background: Single technology appraisals (STAs) are a key component of the development of NICE technology appraisals guidance, but are a time and resource intensive process. Societal costs are incurred during STAs by holding the NICE Appraisal Committee, via payment to the evidence review group (ERG) and in the opportunity costs of other technologies which are not appraised. In addition, the drug manufacturer also incurs substantial costs in preparation of their submission and throughout the STA process. Recently aripiprazole, an atypical antipsychotic drug for the treatment of manic episodes in adolescent bipolar I disorder, was subjected to an STA and received positive guidance. It was apparent to the ERG from the outset of the appraisal that the conclusion would be positive as: the drug had a small acquisition cost; was already in widespread use; would shortly be going generic; and had a profile similar to its comparators. As the budget impact over a 5-year period estimated by the manufacturer was less than the payment received by the ERG, it was unlikely that the STA represented efficient use of resources. Given a fundamental role of NICE is in assessing cost-effectiveness, the option of un-referring STAs in rare circumstances has appeal. Recommendations: It is proposed that if certain criteria are met then it would be more cost-effective to not proceed with an STA. These include: small patient population, commonly used in current clinical practice, patent expiring in the near future, and similar levels of efficacy and acquisition cost as key comparators Conclusion: In rare circumstances conducting an STA may not be cost-effective. It is possible that this can be predicted early in the STA process and we propose criteria to aid in this decision. When these criteria are met the possibility of “unreferring” the topic is likely to be the most cost-effective option.