OBJECTIVES:This outlines the lessons learned by the author who is Director of one of the six units in the UK that undertake independent academic evaluations of Technology Assessment Reviews for NICE. The author provides an insiders' view of the major issues that arise in managing the evaluation process. METHODS: The Liverpool TAR group assists NICE to provide guidance on appropriate treatment for specific conditions in specific sub-groups of patients. The aim is to standardise clinical practice around the most clinically and cost-effective interventions. The aim is to spread cost-effective new treatments more quickly across the health service to promote successful innovation on the part of the pharmaceutical industry. The importance of this UK initiative goes beyond its national borders as other governments are guided by NICE judgements in their reimbursement decisions and many are developing similar systems of appraisal. RESULTS:The paper analyses the impact of the six-stage structure of NICE evaluation and assesses how generalisable the process may be to other countries. Issues underlying the targeting of NICE appraisals will also be examined together with the challenges presented to the pharmaceutical industry by the NICE initiative. Although it remains a fairly recent innovation, it would appear to be timely to undertake an initial assessment of its implications, both for the pharmaceutical industry and for national health systems. CONCLUSIONS:The nature and extent of the learning process through which NICE has progressed will be explored, together with the current state of the art with regard to NICE evaluation. In addition, the potential benefits that arise to health services from a NICE-style appraisal process will be presented. Methods by which the clinical and economic evaluations can be integrated will be presented.