When employing the strut-and-tie modelling (STM) method in the conceptual design of reinforced concrete structures, a suitable strut-and-tie (ST) model indicating load transfer mechanisms first needs to be identified. Topology optimization (TO) methods have frequently been used for this purpose. However, although TO methods employing either a ground-structure or a continuum-based TO approach can be used, the performance and effectiveness of these two methods have not been systematically investigated and compared. To obtain a better understanding of the characteristics of both methods, a systematic comparison procedure is proposed to investigate the generation process and the resulting ST designs. Three aspects, relating to structural performance, economic issues, and method applicability are considered in the comparison, with six metrics formulated to quantify these aspects. Based on investigation of designs for three reinforced concrete elements incorporating typical discontinuity regions (two 2D cases and a 3D case), the performance of the two methods is assessed. It is found that both methods result in safe and efficient ST designs, with comparable structural performance, while some differences in terms of computation time and usability are observed.