OBJECTIVES: The meaning of 'value' and the criteria for judging it are increasingly being debated in countries with established reimbursement processes using Health Technology Assessment (HTA). The objective of this study is to determine the criteria used in decision-making to determine value in OECD countries’ decision-making processes using health economic analysis (HEA). METHODS: A review of reimbursement agencies’ websites, relevant literature and contact with individual agencies identified the criteria used to determine value for medicines in processes using HEA. Countries are categorised by how HEA is used in decision-making processes, nature of the cost-effectiveness threshold range (explicit, implicit, no threshold), threshold range where identified and the use of such evidence alongside other decision-making criteria (burden of disease, severity, innovation and others). Details of the judgments reported with respect to the criteria in documents justifying the decision are examined. RESULTS: Twenty-four OECD countries use formal HTA of which 17 require HEA in submissions for certain medicines. Cost-effectiveness thresholds are identified in nine countries, explicitly stated in three. Implicit threshold ranges are identified in four (based on past decisions), whilst in two implicit willingness-to-pay thresholds are used for decision-making. Use of HEA is always accompanied by other criteria (severity, need, burden of disease, end of life, innovation, amongst others). Some countries use cost-effectiveness thresholds central to their decision-making, some report them equally amongst other criteria, whilst in others it is unclear how such criteria is judged. Details relating to the judgement of criteria used in appraisals are sparse. CONCLUSIONS: Multiple criteria are common in countries using HEA, although some are country specific. Reporting of these criteria and their respective use and interpretation alongside the cost-effectiveness threshold range suggests variation in the meaning of value. Multi-criteria decision analysis could provide clarity in the justification of the reimbursement decision and the meaning of value.