The National Institute for Clinical Excellence (NICE) uses economic evaluation as the means to assess new treatments: this is a process unfamiliar to many clinicians. High technology treatments used in paediatric intensive care are expensive and have been subject to economic evaluation. A systematic review of the literature was performed for economic evaluations of treatments used for critically ill children with cardio-pulmonary failure. Of 3604 potentially eligible studies identified, there were 16 cost minimisation studies addressing applicable treatments but only 9 cost effectiveness or cost utility evaluations were found and subjected to review. Three studies dealt with the UK trial of extracorporeal membrane oxygenation (ECMO) for neonates, two studies addressed ECMO and transplantation in paediatric cardiac patients, two studies evaluated ECMO in mixed paediatric respiratory failure populations and two studies assessed the cost effectiveness of inhaled nitric oxide in neonatal respiratory failure. There are inherent problems in performing economic studies in this paediatric field. However, economic evaluation with adherence to guidelines is recommended. Given recent NHS reforms, it is clear that economic evaluation will remain an important focus of debate and is likely to become more prevalent rather than less.