OBJECTIVES: To compare HTA recommendations of Agency for Health Technology Assessment (AHTAPoL) in Poland with HTA recommendations of the Scottish Medicines Consortium (SMC) by drug technology submitted to both Agencies for the same indication. METHODS: From 66 submissions, appraised by AHTAPol in the period January 1- December 31 2008, only drug technologies submitted to SMC for the same indication, were selected.  Where there was more than one submission to a single Agency for the same indication, the most recent outcome was included. Appraisals were grouped into positive and negative recommendations. The clinical and non-clinical reasons for rejection of use were studied. The positive recommendations were divided into guidance with major, minor and without restrictions. RESULTS:  Forty-eight drug technologies were appraised by both Agencies. Similar recommendations were issued in 31 cases. A contradictory guidance was given at 17 occasions.  Negative recommendations constituted 40% and 25% of all HTA appraisals issued by AHTAPol and SMC respectively. While clinical reasons prevailed in Poland (14 of 19 cases), poor economic data was the most often stated reason for negative guidance in Scotland (7 of 12 cases). Positive recommendations constituted 60% and 75% of all HTA appraisals issued by AHTAPol and SMC respectively. Major restrictions prevailed in both countries: 22 of 29 and 23 of 36 in Poland and Scotland respectively. AHTAPol issued 6 recommendations with minor restrictions. There were no such cases in Scotland. At the same time, SMC issued 13 positive recommendations without restrictions. AHTAPol generated only one such guidance. CONCLUSIONS: The positive HTA recommendations were more common in Scotland than in Poland in the group of drug technologies submitted to both Agencies for the same indication. While a clinical aspect was the most common reason for rejection in Poland, SMC pointed out mainly economic issues in their negative recommendations.