OBJECTIVES The aim is to compare the drug reimbursement decisions of innovative anti-cancer drugs in five countries (UK, France, Italy, Spain & Australia). Our approach was to identify both convergence and divergence in these reimbursement decisions and to assess the agreement level between the policy makers. METHODS For our analysis we have used 39 oncology drugs authorized by the EMA between January 2004 and December 2012 covering a total of 65 indications, and we have compared the reimbursement decisions in theses 5 countries. We reviewed the technology appraisal performed by their respective national HTA agencies and their reimbursement decisions.  We have also analyzed the level of agreement for reimbursement decisions between pairs of each country with kappa scores. RESULTS Out of these 39  drugs, only 16 drugs were reimbursed in Australia, 15 in England, 38 in France, followed by Italy and Spain, which respectively reimbursed 29 and 28 drugs. When we have analyzed the common reimbursement decision taken, we have observed that between France and Italy 72% of common positive reimbursement decision were taken, and between France and England only 33 % of positive reimbursement decisions are common. In contrast we have found 49 % of common negative reimbursement decision between England and Australia. Then we have measured the consistency between decision makers with KAPPA scores and it came out that France, Italy and Spain are often in agreement in their reimbursement decisions, and that conversely France and England decisions are significantly in disagreement CONCLUSIONS This study demonstrates that the discordance between countries reimbursement decisions, in most cases may reflect the differences in the decision making process (Eg. France Vs England). But this analysis cannot be conclusive. This is why we have carried out further researches using larger datasets allowing us to highlight some elements yielding to these reimbursement decision differences between countries.