Objectives:This study describes the development of a framework for health technology decisions, for Ontario Health Technology Advisory Committee (OHTAC) in Ontario, Canada.Methods:OHTAC convened a “Decision Determinants Sub-Committee” in January 2007, which undertook a systematic literature review and conducted key informant interviews to develop an explicit decision-making framework.Results:The “Decision Determinants Sub-Committee” offered recommendations about decision criteria, and the process by which decisions are made. Decision criteria include (i) overall clinical benefit, (ii) consistency with societal and ethical values, (iii) value for money, and (iv) feasibility of adoption into the health system. The decision process should be transparent and fair and should use a deliberative process in delivering recommendations.Conclusions:This methodology is currently being pilot tested in a live environment: OHTAC. It will be evaluated and revised according to its feasibility, acceptability, and perceived usefulness.