Encouraging the establishment and growth of technology-based ventures continues to be the focus of attention from policy-makers globally, linked to enhanced levels of innovation, economic activity and wealth/employment creation. Higher education institutions (HEIs) are prominent among the public, private and not-for-profit organisations supporting the commercialisation of scientific outputs. Modes and vehicles adopted include spin-outs, science parks, intellectual property exploitation and different forms of incubation activity. Some HEIs in the United Kingdom have significant experience of commercialisation and technology transfer activities and have developed markedly different approaches. Meanwhile, HEIs in India are broadening their attention from their teaching-research focus to wider engagement in supporting venture creation. While approaches differ between HEIs all face issues of efficacy and sustainability. Set within the wider context of the HEI commercialisation agenda this paper focuses on incubation models, with particular attention to efficacy and sustainability dimensions. Using six case studies (three each from UK and India), we identify contrasting ways in which incubation was undertaken. Findings raise questions regarding whether and if so how HEIs should be involved in the business of incubation to enhance efficacy and provide a more broadly-based and robust platform for underpinning sustainability.