OBJECTIVES: Cost-effectiveness analyses play a key role in the reimbursement of healthcare technologies and require healthcare resource use (HRU) cost inputs. Inaccuracies in inputs can lead to potentially significant differences in results. Thus, the availability of HRU costs is vital for decision-making. This study’s objective is to assess the transparency and ease of access to HRU costs in France, Germany, Italy, Spain and the UK. METHODS: A targeted search and contact with country-specific representatives highlighted existing national documentation.   A cross-sectional selection of costs were searched for including GP and nurse costs; hospital bed and overhead costs; drug prices; follow-up/out-patient visit costs; and the availability of Diagnosis-Related Group (DRG) codes and tariffs. The transparency and availability of costs were assessed using the following criteria: the date, access restrictions and the need for assumptions to generate cost estimates. RESULTS: DRG tariffs were identified for all countries, but the availability of other data varied. Drug prices were obtainable online (such as the website MedicPrix, France), but others required paid registration (Giofil, Italy). The UK had the most accessible primary and secondary care HRU cost data through PSSRU. Italy was the least transparent however AIFA informed us a website reform will increase access to data in 2014. Where not explicit, HRU costs can be indirectly derived from total procedure codes (for example through ATIH, France). Spain and Italy’s regional structure made sourcing national cost data challenging, resulting in wide ranges in input costs in published cost-effectiveness analyses. CONCLUSIONS: Whilst some nations provided transparent HRU cost data, others did not, causing inconsistent inputs across cost-effectiveness analyses. To minimise inconsistency we propose a hierarchy of evidence for use when sourcing costs: • Govt/health service official sources • Official international websites (OECD/WHO) • Published economic studies • Published non-economic studies • National expert opinion • Unofficial websites/sources