OBJECTIVES: The British Isles comprise 4 countries, each with their own distinct Health Technology Assessment (HTA) body: National Institute of Health and Care Excellence (NICE) in England, National Centre for Pharmacoeconomics (NCPE) in Ireland, Scottish Medicines Consortium (SMC) in Scotland and All Wales Medicines Strategy Group (AWMSG) in Wales. Although all four bodies are obligate cost-utility HTA agencies, they do utilise distinct assessment processes. This research aims to compare the number and type of appraisals and recommendation rates between these bodies during 2014. METHODS: All publically available NICE Single Technology Appraisal, SMC, NCPE and AWMSG HTA reports were identified in 2014 and the drug, indication and outcome extracted. RESULTS: NCPE conducted the greatest number of appraisals (60) followed by the SMC (52), NICE (29) and the AWMSG (25). However, it should be noted that 68% of NCPE appraisals were through its rapid review pathway (not needing a full pharmaco-economic assessment). The highest rate of positive full recommendations was made by NICE (86%), followed by AWMSG (84%), SMC (79%), and the NCPE (39%). However, there was variation in what proportions of these recommendations were for a restricted sub-population: SMC (47%), AWMSG (29%), NICE (15%) and NCPE (5%). The proportion of oncology drugs appraised was highest by NICE (37%) followed by NCPE (37%), SMC (21%) and AWMSG (4%).   CONCLUSIONS: The NCPE reviewed the greatest number of medicines but also had by far the highest rejection rates. Although NICE, AWMSG, and SMC had similar acceptance rates, the SMC displayed a greater propensity to restrict indications, and AWMSG (and to a lesser extent the SMC) reviewed a low number of oncology drugs, typically high cost agents that have greater difficulties in attaining positive reimbursement decisions. Thus it appears that in 2014 NICE appeared to be the most generous HTA body in awarding positive recommendations!