OBJECTIVES: The patient perspective is considered critical for policy decision makers. However it is unclear how this perspective is incorporated within different  HTA processes.  The research identified and compared how selected European HTA agencies incorporate the patient view in the decision making process for drugs. METHODS: We identified websites of six relevant European bodies: England (NICE), France (HAS), Germany (IQWIG and GBA), Scotland (SMC) and Sweden (TLV). We searched for: how PAG representatives are selected, how they provide input & contribute to the decision making process and how they are supported by HTA.  Findings  were transferred to  Excel spreadsheet and sent to respective agencies for validation. Five of the six HTA responded.  RESULTS: No  weighting exists on  how Patient Advocacy Group (PAG) input is measured with respect to other data submissions, important differences were observed in the engagement of  PAGs  as part of the HTA assessment. HAS appears to have little or no process for PAG involvement in HTA. NICE, SMC and GBA provide a support unit to facilitate PAG input.  The selection process of PAG for involvement in the process is well defined for G-BA, TLV, NICE and SMC  though TLV uses PAGs not related to the disease area under review. G-BA & IQWIG involve individual patients,  PAGs  & consumer groups. Comprehensive PAG input to the process is publicly available for NICE and SMC.  Only TLV offers an equal voting right for PAGs.   CONCLUSIONS: The patient perspective is a  significant contributor  in the HTA decision making process. Although all HTA agencies rely on patient information, significant differences exist in methods of selection, input, impact and effort to support PAG input.  Although such differences are likely linked to cultural differences there is a need to improve and standardize  PAG input and integration  in HTA decision making.