OBJECTIVES: The Pediatric Economic Database Evaluation (PEDE) Project features a database of 787 pediatric economic evaluations published between 1980 to 1999. Our research objective was to use the PEDE database to examine trends in the application of health economic methods to a pediatric population. METHODS: Frequency distributions and cross-tabulations were performed on the following variables: period of publication, age group, ICD-9-CM category, intervention, outcome and analytic technique. RESULTS: The number of publications increased six-fold between 1980-84 to 1995-99 from 61 to 440 citations per 5-year period. Thirty-two percent of all studies were published in journals for pediatrics or perinatal medicine and 26% appeared in sub-specialty journals. Cost-effectiveness analyses were most frequent, representing 74% of all studies. Throughout the period, the proportion of cost-effectiveness analyses increased by 50%, and decreased for cost-benefit and cost-minimization analyses. Although most studies were performed in children (1 to 12 years of age), this frequency decreased with time while studies in infants became more prevalent. Most publications were classified under the infective and parasitic ICD-9-CM category, comprising 24% of studies. Health prevention studies became less frequent and health treatment studies more predominant with time. Most studies consisted of malaria control and vaccination strategies for hepatitis B, Hemophilus influenzae type B, measles, and varicella. The most common health outcome measure was cases of abnormality, which accounted for 42% of outcomes. CONCLUSIONS: The number of pediatric economic evaluations is steadily increasing with most publications representing health prevention interventions. The majority of publications include cost-effectiveness analyses, especially among children aged 1 to 12 years. Further research is ongoing to determine how the quality of the studies has changed over time.