OBJECTIVES: New cancer treatments pose a substantial financial burden on patients, their families, and society as a whole. Cost-utility analyses (CUAs) provide necessary information on the value for money and are widely published in the medical and economic literature. We describe the growth over time of cancer-related CUAs and investigate whether methodological quality has improved. METHODS: We systematically searched the English-language literature for original cancer-related CUAs published through 2006 using Medline and other databases. Two trained readers independently audited each study and collected data on a variety of elements related to study origin, methods, and reporting of results. RESULTS: We identified 200 cancer-related CUAs (currently included in the Tufts Medical Center Cost-Effectiveness Analysis Registry; www.cearegistry.org). The average annual number of studies has increased from 7 during 1988-2001 to 22 during 2002-2006. Leading sites studied were breast (34%), colorectal (12%), and hematological (12%) cancers. Studies have pertained to the U.S. (53%) U.K. (10%), Netherlands (8%), and Canada (7%) and examined interventions for tertiary care (71%), secondary prevention (22%), and primary prevention (7%). The pharmaceutical industry funded 25% of studies, 41% were funded by non-industry sources and 32% did not disclose any funding source. The median reported cost-effectiveness ratio (2007 values) was $32,000 for breast cancer, $17,000 for colorectal cancer, and $39,500 for hematological cancers. Although adherence to recommended methods has somewhat improved in recent years, the average quality of studies (on a 1-7 Likert scale) was 4.2(±1.1) and did not change substantially. CONCLUSIONS: The economic impact of cancer related interventions has received increased attention in the medical literature due to the very high cost of many newer cancer drugs. The lack of change in the quality of published studies suggests that journals should adopt a more rigorous review to help ensure that authors adhere to guidelines for conducting and reporting CUAs.