Introduction: Depending on countries and health systems, medico-economic assessment guidelines recommend to adopt one or several perspectives. We conducted a systematic literature review in order to assess the fit between the country guidelines and the perspectives announced in the published studies. Areas covered: Searches were carried out within the Medline electronic database for records published between 1 January 2000 and 31 August 2020. Only studies from countries in which guidelines recommending a perspective to adopt were available online were selected. Expert opinion: A total of 398 studies were included. Among those studies, 212 (54.9%) adopted as a main perspective a public payer perspective, 141 (36.5%) a societal perspective, 25 (6.5%) a hospital perspective, and 8 (2.1%) a patient perspective. Recommendations in terms of perspective were followed by 267 (67.1%) studies, mainly from Canada, the UK, and the Netherlands. Two thirds of the perspectives chosen in studies were in line with the recommendations. While the choice of a perspective does not question the quality of the studies published, it raises the question of the relevance of the perspectives that must be adapted to the question asked, the pathology studied, and the feasibility of the studies.