OBJECTIVES:  To identify trends and adherence to pharmacoeconomic recommendations in the use of direct and indirect utility elicitation techniques in published cost-effectiveness analyses from seven countries with clear guidelines on a preferred utility method. METHODS:  We analyzed data extracted from cost-effectiveness analyses (CEAs) included in the Tufts Medical Center CEA Registry, a database with detailed information extracted from CEAs published in peer-reviewed medical and economic journals. Using studies published from 2000-2014 in the US, UK, the Netherlands, Sweden, Italy, Belgium, and France, we analyzed the proportion of utility weights elicited by different methods of direct or indirect elicitation. We excluded utilities that did not have an elicitation method stated in the CEA study (48%; n=5,853), and utilities used in multi-country studies (3.7%; n=475). RESULTS:  From 2000-2014, the EQ-5D was the lead and trending utility elicitation method cited in CEAs published across all countries, including those that recommended the method in their guidelines (US, UK, Netherlands, Sweden and Belgium) and those that did not (Italy, France). In 2010-2014, most utilities from studies based in countries that recommended the EQ-5D method adhered to guidelines (70.5% in the UK, 83.8% in the Netherlands, 79.9% in Sweden, and 52.5% in Belgium). The US, which recommends a generic instrument, also predominately used EQ-5D (32.3%), followed by time trade-off (19.7%), standard gamble (13%), and the visual analog scale (5.2%). The EQ-5D remained the leading utility elicitation method cited even in CEAs from countries that advocated for use of alternative methods in their guidelines (45% in France and 29.9% in Italy; 2010-2014). CONCLUSIONS:  The EQ-5D has become the most cited utility elicitation method in published CEAs, despite alternative recommendations in certain countries including Italy and France. This could have important implications for decisions about resource allocation.