<p>Pharmacogenomics (PGx)-guided prescribing is a promising approach to reduce variability in drug response, although its cost-effectiveness remains uncertain. We performed a systematic review and meta-analysis evaluating the cost-effectiveness of PGx-guided prescribing compared to standard care in psychiatry. In January 2026, we searched MEDLINE, Embase and PsycINFO for studies published between 2014 and 2025. We included any peer-reviewed study that included adults with a diagnosed psychiatric disorder, comparing PGx-guided prescribing to standard care, and reported both quality-of-life and economic outcomes. Given the lack of consensus on synthesising economic evidence, both a narrative synthesis and meta-analysis were conducted. Pooled incremental net benefit (INB) was used as the effect measure for the meta-analysis and heterogeneity measures including the I² test were used to assess heterogeneity and determine which model to use for the meta-analysis. From an initial 1 271 records, 17 studies were included. The narrative synthesis found that 88% of studies favoured PGx-guided prescribing. Meta-analyses produced positive, though non-significant, pooled Incremental Net Benefits (INBs) for the total study groups (£1 623.14, 95% CI: -£116.50 to £3 362.79, <i>p</i> = 0.07, I² = 100%), and for a statistically homogeneous subgroup (£41.54, 95% CI: -£18.27 to £101.35, <i>p</i> = 0.17, I² = 0%). Our review indicates that PGx-guided prescribing can be cost-effective in psychiatry but highlights the need for increased consensus in economic modelling methods.</p>