OBJECTIVES: Economic analysis has traditionally been utilized in health care decision making when applied to high-cost medical technologies. However, healthcare decision making in the United States (US) seldom considers ethical principles such as distributive justice. There tends to be an inherent conflict between cost-effectiveness and patient’s interest. How these conflicts are resolved, needs to be informed by both economic and ethical analysis. The study objective is to assess the extent to which ethical principles are utilized along with economic analysis in healthcare decision-making. METHODS: A systematic literature search was conducted among peer-reviewed journals in electronic databases such as Scopus and EconLit.  No time-frame was stipulated for these searches and inclusion was not limited to the language or the country where the study was conducted. RESULTS: A total of 81 articles were identified and 17 studies were reviewed based on the inclusion/exclusion criteria. The review supported an integration of evidence, economics and ethics in health technology assessment (HTA). Some ethical perspectives discussed in the HTA included: decisions should be accountable to democratic procedure and citizen participation; balance between utility and fairness; and inherent conflict between provider fiduciary responsibility to patients and cost effectiveness. Developing criteria for allocation of high-cost medical technology was the most discussed issue. A survey of health professionals from Western Europe documented that 90% believed ethical analysis was important in HTA but was constrained by practical issues. CONCLUSIONS: The incorporation of ethical perspectives into health care decision-making is still in its infancy. No efforts have been taken so far to assess the importance associated by the healthcare decision-makers to incorporate ethical principles into practice. The review serves as an initial basis for a survey to study US decision-makers’ perspectives about the integration of evidence, economics and ethics in health care decision making.