A287were conducted. Results: Mifamurtide, gefitinib, natalizumab and tocilizumab were included in the study. Results depict how micro-level variables influenced these decision processes. These include: managed entry agreements, ICER levels, orphan, type of evidence appraised and how it was interpreted (dealing with uncertainty). Their interface with macro-level variables was explored. These included, among others, the advisory or regulatory nature of the HTA bodies, the ability to carry out external reviews of the evidence, stakeholder involvement processes or the initiator of the HTA process. For example, patient input contributed to addressing uncertainty in countries with formal processes for patient involvement, but not in those without a formal process. ConClusions: Results demonstrate the close association between the micro and macro-level factors. Nevertheless, there were instances where no clear pattern or relationship between these two levels arose. These may relate to micro-level variables, such as the subjective interpretation of the committees making the decision, or to contextual elements, such as a country's industrial policy. We conclude that although these processes are systematic and rely on evidence-based medicine, a component of these decisions rely on judgments made during the deliberative process.