OBJECTIVES: Within the National Institute for Health and Care Excellence (NICE) Appraisal process, quality adjusted life years (QALYs) are regarded as having equal weighting. However, in January 2009, NICE introduced the end-of-life (EOL) criteria, giving more weight to QALYs for life-extending, and EOL interventions. In May 2014, the Scottish Medicines Consortium (SMC) introduced the Patient and Clinician Engagement (PACE) process for evaluating EOL medicines and medicines used to treat very rare conditions, to allow a more flexible approach to considering such medicines. These two initiatives allow a greater cost per QALY gained willingness-to-pay threshold than usual in the United Kingdom (UK), however there are differences in their requirements and outcomes. The aim of this study was to compare the process and conclusions drawn by NICE and the SMC for health technology appraisal submissions either meeting NICE EOL criteria after May 2014, or being accepted into the PACE process based on EOL. METHODS: All technologies reviewed under the PACE process, NICE EOL criteria or both were identified. Information collected included whether EOL criteria were met, incremental cost effectiveness ratio (ICER) and SMC and NICE decisions. RESULTS: In total, 15 technologies were reviewed. Of the 15, 14 were reviewed under PACE; 8 were given positive SMC Advice, 3 were given restricted positive SMC Advice and 3 were given negative SMC Advice. Of the 14 technologies reviewed under the PACE process, 7 were reviewed by NICE, 4 met EOL criteria, 2 of which were given positive NICE Guidance. CONCLUSIONS: Of those technologies considered by both NICE and SMC since May 2014, fewer met the NICE EOL criteria than the PACE EOL criteria, and fewer still received positive NICE Guidance. There are differences in access to interventions for diseases with short life expectancies within the UK, although further research into the changing Cancer Drugs Fund is needed.