OBJECTIVES: In January 2009 NICE introduced supplementary advice to aid patient access to end-of-life treatments. The advice allowed existing cost-effectiveness thresholds, with an estimated upper limit of £30,000 per QALY, to be extended to treatments indicated for patients with a short life expectancy, provided they apply to small patient populations and are shown to extend life by at least 3 months. Previous research has determined this extended threshold to be around £50,000 per QALY. The aim of this study was to investigate the trends in end-of-life appraisals and recommendations since their introduction in 2009. METHODS: NICE single technology appraisals for cancer therapeutics were reviewed from 2008 to 2013. ICERs were extracted from appraisals evaluated against the end-of-life criteria. RESULTS: During the timeframe considered, 31 appraisals were evaluated against the end-of-life criteria. Of the 21 appraisals considered to meet the criteria, 13 were recommended for use on the NHS, with ICERs ranging from £31,800 to £51,800 per QALY. However, between 2009 and 2013, the average yearly ICERs for end-of-life appraisals increased from £41,633 to £72,667. This general increase was reflected by a subsequent decrease in approved treatments over time. Between 2010 and 2012, 8 end-of-life treatments were approved; this is compared to 5 recommendations issued in 2009 alone. In 2013, no new end-of-life treatments were approved by NICE, with a lowest ICER in the submitted appraisals of £50,200 per QALY. CONCLUSIONS: The general trend of increasing ICERs in new end-of-life cancer appraisals has resulted in fewer treatments being approved by NICE in recent years. Given the limiting effect this could have on improving patient access, this may mean that patients need to rely on other funding sources, such as the Cancer Drug Fund in England, to access novel cancer therapeutics.