OBJECTIVES: To evaluate the time spent from the creation or charter of an HTA agency to endpoints indicating their effectiveness, such as publication of assessments and evidence of the incorporation of assessment into meaningful appraisal influencing patient access to health technologies. METHODS: This study looks at the creation of HTA agencies (e.g. AHRQ, HIQA, IQWiG, PBAC, CADTH and NICE) and their evolution in terms of roles in assessment (advisory, coordinating, decision-making) and the relationship they have with appraisal. RESULTS: It has been demonstrated that the time it takes for an agency to generate assessments impacting patient access varies widely. For example, in Ireland, HIQA was chartered in May 2007, and entrusted with performing HTA assessments. In 2008 and 2009, HIQA has published one health technology assessment per year, both of which were received and in turn implemented by the Minister for Health and Children. In comparison, NICE in the UK was founded in 1999, but its appraisals were not supported by mandate until 2005. Meanwhile, HTAs driven by DAHTA@DIMDI in Germany are known to rarely play a role in pricing and reimbursement. CONCLUSIONS: The evolution of HTA bodies has varied from country to country. However, evolution in scope and impact may provide useful lessons for countries where HTA is receiving renewed emphasis or where appraisal is under consideration for implementation, especially as new agencies are created and existing agencies evolve.