Objective: Technology appraisal systems have been introduced in England, Scotland and Canada in an effort to shorten the assessment process. The study rationale was to review, summarise and critique appraisals published by each system over the last two years, in order to draw comparisons and analyse themes and trends. Methods: A database was developed to collate data from submissions appraised by the National Institute for Health and Clinical Excellence (NICE), the Scottish Medicines Consortium (SMC) and the Canadian Agency for Drugs and Technologies in Health (CADTH) between November 1, 2005 and October 31, 2007. Data collated included the total number of submissions appraised, interventions approved, and time taken to provide guidance. Inconsistencies in the decisions made by each appraisals process were also analysed. Results: Over the two years, a total of 18,135 and 32 submissions were appraised by NICE, SMC and CADTH, respectively. Of the total submissions, NICE approved 17; SMC and CADTH approved 75 and 28, respectively. SMC processed 22 re-submissions compared to 1 and 14 by NICE and CADTH, respectively. CADTH took an average of 6.5 months to provide guidance from the date of submission compared to 14.2 months taken by NICE. SMC took the shortest time, providing guidance within an average of 2.4 months. A total of 27 submissions were appraised by more than one appraisal system, of which 19 resulted in contradictory types of guidance. Conclusion: The number of submissions appraised and the time taken to receive guidance varies greatly across the three appraisal systems. NICE have the longest and perhaps the most rigorous review system reflecting the transparency of guidance issued. In contrast, the SMC issues guidance on seven times more submissions but reports higher re-submission rates. Reviewing the system behind appraising technology assessments may inform future strategic and tactical planning of submissions.