The National institute for Health and Care Excellence (NICE) reached 17 years old in April 2016. As clinicians, we are reading and discussing NICE guidelines on a daily basis in multidisciplinary team meetings. NICE is always in the news, whether for the right or wrong reasons and the organisation will especially make headlines when it says no to recommending a drug for cancer. The cost-effectiveness of any drug or procedure seems to go hand in hand with its clinical effectiveness. This article will be of huge interest to uro-oncologists, senior managers and health commissioners.