Economic evaluations of health care programmes and treatments have now been conducted for about 30 years. A number of key methodological principles have been specified and there has been an exponential rise in the number of published studies. However, there is relatively little evidence of the use of these studies in decision making about health technologies. Therefore, this paper considers what policy issues are amenable to economic analysis, or could be greatly informed by economic appraisal results. It is concluded that a wide range of mechanisms exist to influence the diffusion and use of health technologies and that economic appraisal is potentially applicable to a number of them. The paper also considers how economic appraisal could be made more relevant to decision making. It is concluded that methodological standards need to be maintained, that evidence needs to be produced in a timely fashion, that the local validity of study results needs to be increased, that the dissemination of study results needs to be improved and that more note needs to be taken of the available policy instruments.