OBJECTIVES: The number of economic evaluation studies has grown extensively in recent years. However, a limited number of studies investigated its impact on decision making; the gap is particularly evident in Italy where there are no such studies available. Objective of the research is to evaluate impact of economic evaluation analysis on decision making in the Italian health care system. The prospective taken is that of professionals operating within the system. The aim is to investigate whether there are evident differences in attitudes among professionals who conduct different types of activities. METHODS: A 12 item based questionnaire was sent to 374 health care professionals who had undergone some form of health economics training. The sample was taken from a list of participants of a major health care management program at Bocconi School of Management in the last 10 years. RESULTS: Response rate was 35%. All respondents stated that basics of economic evaluation analysis must be part of the overall knowledge of health care professionals. Grade of usefulness of these arguments in professional activities was rated 3.84 (scale 1-5). Respondents considered that economic evaluation is more largely used in making managerial types of decisions rather than clinical ones (mean 2.94 vs. 2.73). Decisions taken according to short-term perspectives are considered the major barrier in the use of economic evaluation studies, particularly by managers (71%). More training in health economics was indicated as the most relevant facilitating factor for a wider use of studies, by both clinicians and managers (64%). Majority of respondents (80%) considered that the maximum benefits of economic evaluation are taken from its use at the organizational level. CONCLUSIONS: Although economic evaluation has a rather modest impact on decision making in Italian health care, there are some encouraging signs that could lead to its wider and more effective use.