OBJECTIVES: Brain metastases occur in a majority of patients with malignant disease and result in decreased quantity and quality of life.  Treatment alternatives range from whole brain radiation therapy (WBRT), neurosurgery, and the newest modality, stereotactic radiosurgery (SRS).   This article reviews economic evaluations of SRS in the metastatic setting and compares to other treatment options.  METHODS: Studies were included if they were published in peer reviewed journals, primarily in patients with malignant brain metastasis, and at least included a cost analysis between interventions  RESULTS: Uncertainty surrounding the cost-effectiveness of SRS exits due to lack of efficacy information between treatment alternatives, methodological limitations, and design differences between the available studies.  However, when cost –effectiveness ratios are available, SRS appears to be a reasonable option in resource limited settings, with incremental cost-effectiveness ratios (ICERS) just below the $50,000 range.  CONCLUSIONS: Better designed economic analysis in the setting of randomized clinical trials or observational studies need to be conducted to fully understand the economic value of SRS.