Objective To systematically review published cost-utility analyses (CUAs) of postoperative adjuvant chemotherapy regimens for breast cancer patients. Methods Peer-reviewed papers were systematically obtained through electronic database searches of PubMed, Web of Science Core Collection, CNKI and WanFang Data from inception to July 5, 2016.Data were extracted and summarized from literature. Results A total of 14 papers were included. Involving 13574 patients apart from 2 papers undefined the numbers. Studies were conducted in 10 countries, including Britain, the United States, Canada, Spain, France, Iran, South Korea, Thailand and China. Iran’’s results show that FAC was a dominant option versus TAC in short-term.. The incremental cost effectiveness ratio (ICER) of remaining studies ranged from $3114/QALY to $31346/QALY (constant US$). Six studies show that relative to FAC, TAC is a cost-effective adjuvant chemotherapy regimen, whilst the study in Iran found opposite conclusion. Three studies suggest that TC may be considered cost effective compared with AC. Two studies show Adjuvant FEC-D is a cost-effective alternative to FEC 100. One study suggests based on the WHO’s criterion, the regimen of AC with P versus AC is not cost-effective. The other studies show for the average risk woman aged 40 years, compared with E-CMF/FEC60, the FEC-D is cost-effective. Conclusion CUA has been used internationally to evaluate the cost effectiveness of alternative postoperative adjuvant chemotherapy regimens for breast cancer. Owing to the heterogeneity of study design (e.g. research perspectives, research locations, and data sources),the results from literature reviewed in this study may not be applicable to the Chinese context. High quality research from China are required to provide definite conclusions.