Given the necessity to demonstrate that occupational therapy services are a good use of resources, understanding the state of economic evidence is essential. This article presents a of this evidence. Relevant articles were identified using SCOPUS. Eligible studies included economic analyses of interventions that included occupational therapy and were published in English or French after 1999. The findings were synthesized and then appraised using the (QHES) template. The 135 studies identified were conducted in 23 countries and most commonly: with adults/older adults; in home, inpatient, outpatient, and rehabilitation centre settings; with individuals with cerebrovascular accident and orthopaedic conditions. The specific occupational therapy role was specified in 60% of the studies. Approximately 50% of the investigations used a randomized controlled trial and a cost effectiveness analysis, and 40% used a societal economic perspective. The average QHES score was 74.4/100 (reasonable quality). This review has revealed areas of relative strength, some important gaps, and potential directions for future action. Economic evidence that specifically identifies the occupational therapy contribution must continue to be gathered. The profession should consider the strategic alignment of its economic research (e.g., home care) to maximize its impact.