OBJECTIVES: The prevalence of mental disorders and unmet clinical need in Latin America mirror international trends. Barriers to optimal care include lack of knowledge, capacity, stigma and inequitable funding policies which decrease access to guideline endorsed, evidence-based treatments, such as cognitive behavioural therapy (CBT). Decision-making to increase resource allocation for optimal care featuring CBT must weigh both clinical and health economic data. A review of the cost-effectiveness of CBT for mental health disorders has been updated with a focus on research from Latin America. METHODS: PubMed, Embase, Psych Info databases (1985-2006; English, French and Spanish) were searched to identify formal cost-effectiveness analyses of CBT (keywords: cognitive-behavioural therapy, interpersonal therapy, counseling, psychoanalysis, anxiety, obsessive-compulsive disorder, depression, depressive disorder, post-traumatic stress disorder, social phobia, bipolar disorder, personality disorder, eating disorder, psychosis, costs, cost analysis, cost-effectiveness, and economic). RESULTS: From 531 abstracts, 13 studies were identified. CBT alone or in combination with medication, was cost-effective across countries (Australia=5; USA=5; UK=3), and patient populations (mood disorders=8; anxiety disorders=4; psychosis=1), regardless of designs or outcomes employed. No cost-effectiveness studies from Latin America were identified. Cost-effectiveness ratios (CERs) and incremental CERs were uniformly well below accepted thresholds. CBT added to usual care contributed little incremental cost due to offsets from reduced resource utilization. Study limitations include the omission of training and start-up expenditures and lost productivity costs, short time horizons, and variability of response and remission rates. Despite this evidence, increased access to CBT in Latin America will require local data gathering and formal health economic analyses. CONCLUSION: Internationally, CBT is cost-effective. Optimal mental health care featuring CBT is likely to improve clinical outcomes and reduce health care expenditures in Latin America. To help organize and coordinate health economic assessment activities, a research framework is proposed to guide clinicians, researchers and decision makers alike.