University technology transfer offices (henceforth, TTOs) play a critical role in the diffusion of innovation and the development of new technology infrastructure. Studies of the relative efficiency of TTOs have been based on licensing output measures and data from a single country. In contrast, we present the first cross-country comparison of the relative performance of TTOs, based on stochastic multiple output distance functions. The additional dimension of output considered is the university's propensity to generate start-up companies, based on technologies developed at these institutions. We find that US universities are more efficient than UK universities and that the production process is characterized by either decreasing or constant returns to scale. Universities with a medical school and an incubator are closer to the frontier.