OBJECTIVES: The large availability of economic evaluations and their increasing importance for decision making emphasizes the need for economic evaluations that are methodologically sound. The aim of this study is to provide users of economic evaluations of cholesterol lowering drugs with an insight into the quality these evaluations. By focussing on the most relevant studies the gap between research and policy making may be narrowed. METHODS: A systematic review was conducted. All publications on economic evaluations of cholesterol lowering drugs were identified by searching Pub Med, the Centre for Reviews and Dissemination database (CRD), the National Health Service Economic Evaluation Database (NHS EED), the Health Technology Assessment database (HTA) and the Database of Abstracts of Reviews of Effects (DARE). A search strategy was set up to identify the articles to be included. These articles were quality assessed using Drummond's checklists. The scoring was performed by at least two reviewers. When necessary, disagreement between these reviewers was decided upon in a consensus meeting. We calculated an average quality score for the included articles. RESULTS: The search identified 23 articles that were included. Most studies measured the costs/LYG. The overall score per study varied between 2.7 and 7.7 with an average of 5.4. Most studies score high on the measurement of costs and consequences whereas the establishment of effectiveness leaves room for improvement. Only two studies included a well performed incremental analysis. CONCLUSION: This review noticed an increase of quality of economic evaluations over time. Consequently, the value of cost-effectiveness studies for policy decisions increases over time. In general piggy back evaluations tend to score higher on quality and are therefore more valuable in decisionmaking.