OBJECTIVES: In general, demonstrating cost-effectiveness for orphan drugs including orphan oncology agents is challenging. Reasons include high incremental cost per QALY and insufficient clinical evidence. Even in an established Health Technology Assessment (HTA) system such as the UK, orphan oncology agents are often rejected as they are not cost-effective.  In Asia-Pacific, South Korea and Australia employ a similar HTA system. HTA recommendations between the countries, however, are not always comparable.  This research aims to understand the drivers for positive recommendations and implications for improved patient access to oncology treatments. METHODS: Review HTA recommendations in UK, Australia and South Korea for sunitinib, dasatinib, lenalidomide, imatinib and rituximab. Compare and contrast prices, level of clinical evidence and reimbursed patient populations in the context of the specific assessment criteria in each country. Identify drivers for positive recommendations.    RESULTS: Of the selected drugs, more have received positive recommendations in South Korea and Australia than UK. A drug that receives a positive recommendation is usually priced lower in South Korea than Australia or the UK.  Between Australia and UK, Australia tends to reimburse at a lower price. The level of clinical evidence has less impact on evaluations in South Korea. In the UK, if NICE recommends an orphan oncology drug, usually a patient access scheme is included.  CONCLUSIONS: While pricing is not dictated by NICE in the UK, access remains highly regulated. Manufacturers often need to set up patient access schemes in order to prove their orphan oncology drugs cost-effective and optimize patient access. On the other hand, in South Korea, the HTA process is less defined and more driven by minimizing costs. While cost-effectiveness is the main driver for a positive recommendation, formal price negotiation processes in South Korea and Australia lead to access more consistently.