BACKGROUND: As a result of increasing cost consciousness in the health care system, pharmaceutical manufacturers have come under pressure to demonstrate the pharmacoeconomic benefits of their products to health care providers and payers. OBJECTIVE: To analyze the content of economic and health-related-quality-of-life appeals in drug advertisements in primary care and specialty journals. METHODS: Advertisements from specialty and primary care journals from June 1997 to June 1999 were analyzed. Each message was classified by the content of the appeal as one of eight economic or quality-of-life categories: compliance; direct or indirect economic; patient satisfaction; overall well being; or physical, social or psychological function. Appeals were also classified as explicit or implicit depending on their use of economic or quality of life terms (e.g. cost-effective ). Data were also collected on which type of reference the appeal cited: none, data on file or published reference. RESULTS: Sixty-one advertisements were included in the analysis with a total of eighty messages. Appeals were mainly implicit (85%) and related to direct economic messages. Specialty journals had relatively more messages appealing to compliance (29% vs. 8%) while primary care journals had relatively more messages appealing to psychological function (24% vs. 4%). Most appeals cited a published reference to substantiate their message (56%), but 24% of appeals cited no reference. Primary care journals were more likely to cite published references than specialty journals (66% vs. 47%). CONCLUSION: In the absence of clearly delineated regulation by the FDA governing the advertising of economic or quality-of-life-related messages, the pharmaceutical industry has focused on implicit messages, avoiding overt appeals to cost-effective , cost-benefit , cost-utility , QALY or quality of life .