OBJECTIVES: In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) assesses the cost-effectiveness of therapies in England and Wales. In Scotland, the Scottish Medicines Consortium (SMC) is responsible for such decisions. There are recognised differences in how these agencies operate, with the SMC adopting an early, rapid approach to health technology appraisal and NICE favouring a more extensive, detailed review. Conflicting decisions between the two agencies can lead to differential drug availability; however, it is generally believed that the recommendations are broadly the same. The purpose of this review is to evaluate the level of agreement over the last year. METHODS: The NICE website was searched for single technology appraisals (STAs) published between January and December 2010. The appraisals for the same drugs were identified on the SMC website and the recommendations of NICE and the SMC compared. RESULTS: Nineteen STAs were performed by NICE in 2010. These included 11 drugs for cancer indications and an assortment of 8 others. Of the 19 drugs evaluated, NICE recommended 12 and rejected 7. For the same drugs, the SMC recommended 8 and rejected 11. Decisions between the agencies were the same for 13 drugs, equating to agreement in 68.4% of cases. Of the 6 cases where the recommendation differed, 5 were recommended by NICE. In all five cases the SMC found that the economic cases presented by the manufacturers were not sufficiently robust: in one instance weaknesses in the clinical data were also implicated. The one drug recommended by the SMC in contradiction of NICE was also rejected based on cost-effectiveness. CONCLUSIONS: In general, there is reasonable agreement between decisions made by NICE and the SMC. Poor evidence regarding cost-effectiveness is the most commonly cited reason for one agency not recommending a drug.