OBJECTIVES: There is a general consensus on the need for a stronger patient-centeredness, even in HTA processes. In international comparison different ways of public participation (citizens, insured and patients) in the decision-making process are discussed and tested. The need was recognized, but not yet fully reflected in practice. This study describes how preferences can be taken into account in different decision situations and shows how methods of preference measurement/citizens' councils are used in an international context to support decision-making and understand the importance of various decision-criteria that influence these decisions. METHODS: A systematic literature review in PubMed/Medline revealed 95 articles and showed that methods of patients, citizens and policyholder participation are manifold. In order to structure the international approaches further, international HTA-organizations worldwide were questioned via e-mail in the end of 2013 on patients and public participation in their countries. RESULTS:   17 out of 126 contacted organizations answered to these questions. In general, the participation efforts extend from qualitative survey of patients' needs up to the science-based documentaries of quantitative patient preferences. The review and the survey of the HTA-agencies show that internationally three mechanisms are used to involve the public in decision-making bodies: membership of at least one patient representative (e.g., Australia, France, Germany), presentation of oral/written comments from patients (e.g., Australia, Netherlands, Great Britain) and the possibility to check the HTA-reports and the corresponding draft recommendations before publication (e.g., France, Germany, Great Britain, New Zealand, USA). CONCLUSIONS:  The role of the patients or citizens seems to be limited to an informal or ad-hoc basis and is mostly restricted to consulting activities. In order to achieve a patient-centered health technology assessment two ways to sharing information are relevant: the public needs information on medical and health policy/economic issues and decision-maker need information on the patient perspective.