Aim: This paper reviews scientific work of the past decade dealing with the economic evaluation of Occupational Safety and Health (OSH). The focus is on the modelling approaches and practical tools (methods) used to carry out economic evaluations, with emphasis on Small and Medium-sized Enterprises (SMEs). Methods: The search of relevant publications was performed mainly through international bibliographic databases and science search engines, and also by examining citations from other authors. Results: The relevant features of currently available evaluation approaches are described. The main difficulties and/or methodological limitations in this domain are highlighted and discussed; emphasis is put on the needs and particular constraints of SMEs. Conclusions: From this scrutiny, it seems fair to conclude that, no matter the complexity and/or the degree of convergence and divergence between the various approaches currently in use, it is nonetheless consensual that economic evaluation of OSH needs more multidisciplinary research. Moreover, it is also apparent that large corporate groups are already persuaded that "safety pays and rewards" and are engaging in systematic evaluation attempts; by contrast, much more needs to be done to make the case with the smaller enterprises. Impact in future work: Stemming from the literature review, the paper ends with an overall vision (kind of meta-model) to assist the modelling of future tools and includes a research agenda for future work.