Under recent healthcare reforms, the urgent need for establishing evidence-based healthcare and for economic evaluation has been emphasized. Cancer not only accounts for a major burden of diseases, but also has major economic impacts on both individual patients and society. Most cancer therapies are essentially high-cost and high-technology, and provide uncertain outcomes. Concerns about the appropriate choice and utilization of cancer therapy is increasing. However, economic evaluations for cancer therapy are lacking in a number of areas, despite recent advances. In Japan, to catch up with international trends, serious efforts to generate better evidence for economic evaluation of cancer therapy have recently been made. A league table for economic evaluation of cancer therapy in Japan has been constructed, based on results including preventive antiemetic treatment, breast conserving and post-adjuvant therapy for early breast cancer, bone marrow transplantation for leukemia, interferon treatment for hepatitis C with liver cirrhosis, and others. This information shows substantial possibilities for evaluating the value-for-money of cancer therapy. This may lead to the establishment of an effective and efficient healthcare system in Japan.