OBJECTIVES: Cost-utility analysis (CUA) has been extensively used to assess and convey health care intervention costs and health benefits. We examined the growth and characteristics of published English-language CUAs through 2012. METHODS: We analyzed data from the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegisty.org), which contains detailed information on more than 4,000 English-language CUAs published in peer-reviewed journals. We summarized study intervention types, disease areas researched, funding sources, journals of publication and methodological practices over three time periods: 1990-1999, 2000-2009, and 2010-2012. We also investigated the extent to which the number of CUAs focusing on each of several worldwide geographic regions was correlated with regional disease burden. RESULTS: The number of CUAs published steadily increased over time, from 34 annually during the 1990s to 431 annually during 2010-2012. The number of CUAs published during 2012 (n=538) exceeded the number published in 2011 (n=372) by 45%. The proportion of CUAs targeting the US population declined from 61% during 1990-1999 to 35% during 2010-2012 (p<0.0001). Most interventions have focused on pharmaceuticals (47%), followed by surgery (13%), screening (12%) and medical procedures (12%). Of the diseases researched, cardiovascular disease is the most common (18% of all studies), followed by cancer (15%) and infectious diseases (15%). During 1990-2012, 51% of CUAs performed probabilistic sensitivity analyses and 33% included acceptability curves. The proportion of CUAs funded by the drug industry varies substantially across journals. Investigators in low- and middle-income countries contributed an increasing number of published CUAs in recent years. Across all geographic regions, few CUAs have focused on injuries relative to their population burden. CONCLUSIONS: Our review reveals considerable growth and some change in the cost-utility literature in recent years. The data suggest growing interest in cost-utility methodology, particularly in developing countries.