OBJECTIVES: To compare technology-specific cost-effectiveness analyses (CEA) submitted as part of health technology assessments (HTA) in France, England and Canada and to highlight the comments, criticisms and conclusions from the HTA agencies in order to assess the feasibility of a unified approach. METHODS: Newly published health economic appraisals from the French National Authority for Health (HAS) were reviewed, analyzed and compared to technology appraisals and/or evidence review group (ERG) reports in other countries for the same drugs including sofosbuvir (Sovaldi^®), trastuzumab emtansine (Kadcyla^®), riociguat (Adempas^®) and dolutegravir (Tivicay^®). The analysis focused first on the review of methodological approach selected by the manufacturer including model type, time horizon, discount rates, perspective, study population, comparators as well as efficacy, costs and utility data and presentation of results (i.e. total costs and health benefit, incremental cost-effectiveness ratio from both base-case and sensitivity analyses). The analysis then focused on comments made by the agency committees, criticisms and overall conclusions. For each drug, a comparison between models used and agencies’ final recommendations was undertaken to highlight convergent and divergent points between countries. RESULTS: Results were heterogeneous between drugs which made it difficult to draw a general overarching conclusion. Nevertheless, some points were underlined by every agency. As an example, French, English and Canadian HTA agencies all drew attention to small patient samples and their impacts on the robustness of efficacy data for subgroups in several assessments, which led to uncertainty around estimates of clinical effectiveness and therefore cost-effectiveness. CONCLUSIONS: Cost-effectiveness analyses have been introduced in France as part of the assessment of new health technologies two years ago whereas it has been used for about 15 and 20 years in England and Canada respectively. This review highlighted the level of similarities between countries to assess the feasibility of a unified approach to prepare the submission process.