Summary Introduction To evaluate available evidence on the cost-effectiveness of endovascular treatment and neurosurgical clipping for aneurysmal subarachnoid hemorrhage. Results of economic evaluations are needed to gain insight on the relationship between clinical effectiveness and costs of aneurysmal subarachnoid hemorrhage treatment modalities, in order to inform both clinical decision-making processes and policymakers in facilitating Value-Based Healthcare. Evidence acquisitionDatabases (PubMed, Embase, Cochrane Library, the Centre for Reviews and Dissemination, EBSCO, and Web of Science) were searched for papers published until October 2020 performing economic evaluations in aneurysmal subarachnoid hemorrhage patients comparing endovascular treatment with neurosurgical clipping. The quality of reporting and methodology of the economic evaluations were assessed using instruments (i.e. CHEERS statement and CHEC-list, respectively). Evidence synthesis A total of 6 studies met inclusion criteria. All studies reported on both effects and costs; however, five articles did not relate costs to effects. Only one paper related effects directly to costs, thus conducted a full economic evaluation of which the reporting quality scored 81% and the methodological quality 30%. Conclusions The quality of published cost-effectiveness studies on the treatment of aneurysmal subarachnoid hemorrhage is poor. Six studies reported both outcomes and costs, however only one study performed a full economic evaluation comparing endovascular treatment to neurosurgical clipping with sufficient reporting quality, yet with insufficient methodological quality. Research that relates health-related quality of life measures to costs of endovascular treatment and neurosurgical clipping is advised, potentially with different subgroup analyses and modeling, and focusing on both reporting and methodological quality. Relevant documents The records identified through the database searches can be viewed in ‘Database search results’.