OBJECTIVES:  To evaluate the economic impact of routine testing of HIV in antenatal (ANC) settings METHODS:  A systematic review of published articles. Extensive electronic searches for relevant journal articles published from 1998 to 2015 when countries began to implement routine ANC HIV testing on their own were conducted in the following databases: Science Direct, MEDLINE, SCOPUS, JSTOR, CINAHL and PubMed with search terms as listed in box 1. Manual searches were also performed to complement the electronic identification of high quality materials. There were no geographical restrictions but language was limited to English. Fifty-five articles were retrieved; however, ten were eligible and included in review. RESULTS:  The findings showed that many programmes involving routine HIV testing for pregnant women were cost effective and cost saving. Overall, in sensitivity analysis, the cost of the interventions at different settings were impacted by prevalence rate of HIV, the cost of screening for HIV, the overhead cost and the life time cost of treatment of an HIV infected baby. CONCLUSIONS:  Routine HIV testing is both cost-effective and cost saving. However, there is wide variations in the methodological approaches to the studies. Adopting standard reporting format would facilitate comparison between studies and generalizability of economic evaluations.