OBJECTIVES: Acupuncture is widely used for various diseases such as chronic low pain and osteoarthritis, but the cost-effectiveness of acupuncture has not been fully explored. The aim of this review is to summarize and assess randomized controlled trials (RCTs) of acupuncture for economic evaluation. METHODS: Total 5 electronic databases were searched up to May 2009 without language restrictions. The search terms used were "cost effectiveness", “cost utility” and "cost benefit” with “acupuncture”. Studies presenting results of economic evaluation throughout prospective, controlled studies for any medical condition were included. The quality of study was assessed. The main outcomes for health benefit and cost were extracted and described. RESULTS: Thirteen RCTs that met the inclusion and exclusion criteria underwent a full-text review. Acupuncture with usual care was compared with usual care only in all studies. Nine studies were applied for pain condition including low back pain, headache, and dysmenorrhea. The reporting quality of the studies was poor for certain items. Nine studies described incremental cost-effectiveness ratio (ICER) or incremental cost per quality adjusted life year. Most studies suggested that additional acupuncture treatment was cost-effective compare to the usual care for low back pain, headache, dysmenorrhea, osteoarthritis, angina pectoris, and allergic rhinitis.   CONCLUSIONS:  This systematic review showed the cost-effectiveness of additional acupuncture treatment, but including studies were very few and applied diseases were limited. Therefore the results could not be generalized due to diversity of disease and different status of each country. The more number of economic evaluations of acupuncture are necessary to firm the evidence.