The National Institute of Clinical Excellence (NICE) has three main roles. It provides guidance to the National Health Service (NHS) on the use of selected new and existing technologies (the appraisal process), provides clinical guidelines for clinicians and physicians in important treatment areas, and develops audit methodologies. This paper discusses the NICE appraisal process. The specific steps of the appraisal process are described, including the basis for topic selection. An overview of NICE guidelines for manufacturers and sponsors is reported. First-year experience is assessed, reflecting on the quality of submitted evidence, and the content of the forthcoming program is presented. Finally, the impact of NICE appraisals is explored in terms of potential benefits and risks.