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Abstract Survival rates for pediatric acute lymphoblastic leukemia (pALL) have improved dramatically; relapsed/refractory (r/r) acute lymphoblastic leukemia (ALL) remains challenging. Immunotherapies are rapidly evolving treatments for r/r ALL with limited cost‐effectiveness data. This study identifies existing economic evaluations of immunotherapy in pALL and summarizes cost‐effectiveness. Medline, Embase, and other databases were searched from inception to October 2022. Cost‐effectiveness analyses evaluating immunotherapy in pALL were included. Costs reported in 2021 USD. Of 2960 studies, 11 met inclusion criteria. Tisagenlecleucel was compared to standard of care, clofarabine monotherapy, clofarabine combination therapy, or blinatumomab. No studies have evaluated blinatumomab or inotuzumab ozogamicin. Six studies found tisagenlecleucel to be cost‐effective, five of which were supported by Novartis. Four found that it had the potential to be cost‐effective, and one found that it was not cost‐effective. The cost‐effectiveness of tisagenlecleucel was highly dependent on list price and cure rates. This study can inform the use of tisagenlecleucel in pALL.