OBJECTIVES: Different countries might have similar health preferences due to cultural or economic factors. The aim of this study is to identify whether there are groups of countries with similar health-state valuations. METHODS: A cluster analysis was performed for the 242 states of the EQ-5D valuations for 23 published studies in 18 countries. The perfect health state was not included. The Ward algorithm with the Euclidean measure and the hierarchical clustering technique were used in order to identify the optimal number of clusters and the clusters themselves. The features of the resulting clusters were studied and whether there were similarities in the countries belonging to the same cluster. The effect of the valuation methodology, Visual Analogue Scale (VAS) or Time Trade Off (TTO), was also taken into account. RESULTS: Five clusters were identified: 1) Germany-TTO, Netherlands-TTO, Denmark-TTO, Argentina-TTO, Poland-TTO; 2) Belgium-VAS, Europe-VAS, New Zealand-VAS, Spain-VAS, UK-VAS, Denmark-VAS, Germany-VAS, Slovenia-VAS; 3) Spain-TTO, UK-TTO; 4) Japan-TTO, USA-TTO, Zimbabwe-TTO, Hispanic USA-TTO, South Korea 2009-TTO, Finland-VAS, Argentina, VAS; and 5) South Korea 2008-TTO. Valuations are very sensitive to the preference elicitation methodology. Hence, valuations for a country may be more similar to the valuations of another country with the same methodology than to the same country with a different methodology. Countries in the same cluster tend to have cultural similarities (e.g. European countries with the same methodology tend to belong in the same cluster) but a particular cluster grouped otherwise dissimilar countries and methodologies: Japan-TTO, USA-TTO, Zimbabwe-TTO, and Argentina-VAS. CONCLUSIONS: Health-state valuations tend to be clustered in a few groups of countries that share cultural or economic features. These results can be used in sensitivity analyses when performing cost-utility analysis.