OBJECTIVES: There are a number of common elements considered good practice in Health Technology Assessment (HTA) that have been published by organizations representing the field. These components include: clear processes and decision-making, including scope for pragmatic approaches and appeal; transparency in methodology, value judgments and decisions; and a facility for stakeholder involvement. The objective of this study was to compare international HTA systems to rank their performance against the ideal components of HTA. Information was also collected on emerging topics such as combined regulatory-payer scientific advice, coverage with evidence, evaluation of drug-diagnostic pairs and disinvestment. METHODS: A survey was designed to collect information on the HTA systems in the United Kingdom (UK), France, Germany, Italy, The Netherlands, Sweden, Central Eastern Europe, Canada, Australia, New Zealand (NZ), Korea and Taiwan. Questions were grouped under the topics: process, methods, data, societal input and transparency. The survey was completed by Roche affiliates with first-hand experience working with the HTA system in their country. RESULTS: The majority of countries give consideration to rare diseases and low budget impact with leniency in decision making and/or process. Transparency in decision-making is lacking in many of the countries surveyed. Whilst consumer members sit on decision-making committees in several countries, only the UK involves a group of citizens in setting the decision making criteria applied by the committee. Combined regulatory-payer scientific advice is only available in European countries. Australia is the only country to evaluate drug-diagnostic pairings for both costs and outcomes. Only the UK and NZ have routine disinvestment reviews. CONCLUSIONS: Each country is performing well in some elements of their HTA system, but none met all the requirements of an ideal system. HTA systems can learn from the experiences in other countries when considering improvements to processes and efficiency.