Every appraisal involves a systematic review of the available evidence on the clinical effectiveness of the technology of interest (relative to one or more comparators) as well as creation or modification of an economic model to examine the cost-effectiveness of that technology.  The primary findings from both sets of analyses are used to develop the ICER Integrated Evidence Rating™.  This rating system, as depicted in the grid below, involves an uppercase letter grade that informs both the quality of evidence on clinical effectiveness as well as the magnitude of net health benefit, and a lowercase letter grade that relates to the cost-effectiveness of the technology.