OBJECTIVES: To review and compare HTA reports produced by two Italian Regions: Veneto and Emilia Romagna. To highlight analogies and differences between the elements evaluated in the reports and the outcomes of the assessments made. METHODS: A descriptive analysis of HTA reports produced by the Coordinamento Regionale Unico sul Farmaco (CRUF) of Veneto and Commissione Regionale del Farmaco (CRF) of Emilia Romagna. In order to obtain a direct comparison on the assessment methods of the two regions, only reports regarding the same active principles were considered. The analysed reports were published between 2011 and 2014. Coherently with the principle of transparency professed by these HTA institutions, all the data included in the analysis were directly obtained from the agencies’ websites. RESULTS: For all of the 5 drugs analysed in the reports, Veneto and Emilia Romagna considered same elements, such as safety, comparators, indication, and concluded the identical results about them. Both Regions provided always the same efficacy studies; in 2 cases Emilia Romagna evaluated more secondary endpoints, while in 1 it considered more studies than Veneto, nevertheless the two regions drew equal conclusions about efficacy. Different approaches were taken when conducting economic evaluations: both Regions considered drugs’ costs but Emilia Romagna, on the contrary of Veneto, never developed neither a budget impact analysis nor a target population study. Finally, in 3 out of 5 cases Commissions drew different conclusions about the selection of patients to which give the drug to or whether including or not the drug in the Prontuario Terapeutico Regionale (PTR). CONCLUSIONS: Divergences in final decisions highlight different priorities of each HTA region regarding the criteria used to make evaluations. Because of the goal of transparency both Regions have, the lack of evidence of mechanisms they adopt in taking assessments should be filled.