OBJECTIVE: The National Institute for Clinical Excellence (NICE) is a UK government-funded body that responds to requests for guidance from the Department for Health on the use of selected new and established technologies in the NHS in England and Wales. In March 2001 NICE published its “guidance to manufacturers” for these submissions - essentially economic evaluation guidelines for publicly-funded health-care services including, but not restricted to, pharmaceuticals. This presentation analyzes the extent to which the NICE guidelines use economics to contribute to the goals articulated in the NICE documentation for health maximization and to remove unfairness in the availability of technologies under a fixed NHS resource constraint. METHODS: We analyze from an economics perspective the problems giving rise to the need for guidelines, the theoretical basis of the guidelines, and the implications of the guidelines for health maximization and rectifying unfair availability. RESULTS: The NICE guidelines fail to reflect important economic aspects concerned with constrained health maximization and unfair availability. The guidelines cannot be expected to lead to maximization of health gain from NHS resources and hence may fail to serve the needs of NHS decision-makers. In addition, use of the guidelines could result in continued expansion of expenditures as predicted by economic analysis. CONCLUSIONS: The guidelines aim to provide system-wide solutions, based on standardized methods, to what are essentially locally-based, non-standardized problems. Although guidelines might be helpful in dealing with matters of administrative process, the need for or ability of such an approach to accommodate the intellectual substance of the wide range of problems, heterogeneous populations, and differing circumstances faced by decision-makers has yet to be justified.