Other places use QFE for approach as standard - Russia and other 'eastern bloc' countries for example. Now flying as a 'strawberry mivvie' all over the world and I admit it gets confusing toward Moscow when you are working in meters and QFE having become used to QNH and told to 'descent to FL9800 Metres' and then 'alt 900 metres QFE 1001'. It involves using a separate check list to get up the pressurisation system and another crib to convert the metres to feet for the Altimeter Alerting Device.
Mind you I don't find it as difficult a concept as some of my colleagues who have never flown in the military and get all upset about QFE!
MO