OBJECTIVES: To describe research methods and key issues in the HTA process in Europe. METHODS: Representatives from HTA bodies globally were recruited by members of the ISPOR HTA SIG Research Methods/Principles Working Group to complete a 45-minute on-line survey consisting of 48 items within 4 topics related to 1) organizational information and process; 2) primary HTA methodologies and importance of attributes; 3) HTA application and dissemination; and 4) quality of HTA including key issues. Data were reported for Europe. RESULTS: The survey was completed by 11 European countries including Austria, Denmark, France, Germany, Hungary, Italy, Netherlands, Portugal, Spain, Sweden, and Switzerland. Top reasons technologies were evaluated included perceived impact on patient outcomes, potential cost, and prevalence of the condition. The most common methodologies used were cost/economic analyses, systematic reviews & meta-analyses, clinical trials, modeling, and comparative analyses. The most important attributes (in order) were effectiveness, efficacy, safety, cost-effectiveness, and budget impact.  While quality of life was frequently assessed by >74% of European respondents, it was not listed as an attribute of top importance. Only 24% repeat/update the assessment at regular intervals. For 82% a different organization makes the final decision on coverage, only partially relying on the report. The most common educational background for decision makers was physician-specialist. Stakeholders are allowed to review the report and are involved in assessments >50% of the time, and in the final decisions ~35% of the time. Key issues/trends included early assessment of technologies with mechanism for conditional coverage, increasing regional interest in HTA, reassessment/horizon scanning, and link between theory and practice in HTA. CONCLUSIONS: This survey of representatives within HTA and reimbursement bodies provides current insight into the state of HTA research methods in Europe.  Future research could expand the results to specifically address Eastern European countries, Asia, and other emerging markets.