OBJECTIVES: Economic evaluation guideline development has been rapid throughout the world over the last decade. The objective of this study was to establish whether economic evaluation guidelines are needed for the Japanese healthcare system. METHODS: A questionnaire survey of 30 Japanese academics, industry representatives and clinicians was conducted posing five questions on 1) the need for guidelines and their purpose; 2) the willingness of the respondent to participate in guideline development; 3) whether the respondent has conducted or outsourced an economic evaluation in the previous 12 months; 4) predicting when guideline development will take place and 5) what are the current obstacles to guideline development in Japan. RESULTS: There was an 81.5% response rate. One hundred percent of respondents stated that there was a need for economic evaluation guidelines (47.8% for reimbursement, 78.2% to maintain methodological standards and 30.4% as a statement for ethical standards.), of which 82.6% were willing to participate in guideline development and 26.1% had conducted or outsourced an economic evaluation in Japan. The majority predicted that guideline development would take place within the next 3-5 years (56.5%). Obstacles to guideline development included the existing structure of the healthcare system, the lack of coordination from the MOHW or a sponsor, clinical practice variation, slow epidemiological database development and issues regarding appropriate outcome/clinical endpoints. CONCLUSIONS: Although Japan is considered a late-entrant for the adoption of pharmacoeconomics, there have been many encouraging signals in recent years. If these obstacles can be overcome, then economic evaluation guideline development will establish itself quickly on the Japanese healthcare agenda.