OBJECTIVES: To review reported economic evaluations of myocardial perfusion scintigraphy (MPS) for patients with suspected coronary artery disease (CAD); to synthesise and communicate two reviews undertaken to support an appraisal of MPS in this technology by the UK National Institute for Health and Clinical Excellence (NICE). METHODS: Conduct a systematic review to identify published studies reporting economic evaluations comparing diagnostic strategies with and without MPS in patients with chest pain and/or abnormal resting ECG. Studies published between 1984 and 2002 were included, together with two model-based evaluations submitted to NICE in 2003. Results were summarised by source of data, strategy comparison and type of patient. Quality of reported studies and methodological issues were assessed. RESULTS: Twenty-four studies were identified: 12 ‘primary' studies based on analyses of prospective or retrospective data and 12 studies based on decision-analytic modelling. Twenty studies were based in the US and 4 in the UK, one of which used data from a range of European countries. Many studies reported that MPS was a cost-effective alternative to Exercise ECG (ExECG) prior to coronary angiography (CA) in patients at intermediate/high risk of CAD. Evidence for the cost-effectiveness of adding MPS after ExECG (in patients positive on ExECG) was less conclusive. Compared with MPS, direct CA was generally not cost-effective in patients at intermediate risk, but cost-saving for patients at high risk. Studies were of variable quality; for example primary studies based on short term outcomes, and failure to present incremental comparisons. The use of CA as a gold standard for functional imaging tests which provide additional information to the degree of vessel stenosis may be problematic. CONCLUSION: There is evidence for the cost-effectiveness of MPS in patients at intermediate risk of CAD. It would be valuable to confirm this with longer term prospective studies and improved economic modelling.