OBJECTIVES: To identify the Health Technology Assessment (HTA) decision preferences of targeted therapies across the globe by comparing the decision rates and rationale of government-based HTA between Western and Eastern agencies. METHODS: A literature review was conducted to identify decision rates and rationale for targeted cancer therapies from five HTA agencies: NICE in UK, CADTH (pCODR) in Canada, PBAC in Australia, HIRA in South Korea and CDE in Taiwan. This study focused on cancer therapies with biomarkers in the top three cancer types — non-small cell lung cancer (NSCLC), breast, and colorectal cancer (CRC) — based on the GLOBOCAN 2012 report. 17 targeted therapies were selected. Bevacizumab and Alectinib for NSCLC and Ramucirumab for CRC were excluded due to absence of HTA reports in more than three HTA agencies. Consequently, four therapies in breast cancer and five in NSCLC and CRC were reviewed. RESULTS: Seventy HTA reports were identified and reviewed. Fifteen of 70 HTA reports were not available since the assessments were still in progress or have not been published. The positive decision rate for targeted therapies was 69% (n=38) including the conditional positive decision rate of 42% (n=23). Taiwan had the highest positive decision rate, 100% (n=7/7), while NICE was 50% (n=6/12). CRC and breast cancer had same positive decisions rate, 57% (n=12 / 21) and (n=8/14). Instead, NSCLC had a decent positive decisions rate, 90% (n=18 / 20). The reasons of negative decisions included the uncertainty of the clinical outcome (n=7), no comparative effectiveness to standard or current therapies (n=5) and insufficient cost-effectiveness (n=10).  CONCLUSIONS: Based on the selected countries and cancer areas, Asian countries (Korea and Taiwan) were more favorable to targeted therapies than Western countries. CRC and breast cancer had lower positive decision rates compared to general cancer therapy which was 67% and 79% in NICE and CADTH respectively.