Background Heart failure is a major and growing medical and economic problem worldwide as 1–2% of the healthcare budget are spent for heart failure. The prevalence of heart failure has increased over the past decades and it is expected that there will be further raise due to the higher proportion of elderly in the western societies. In this context cost-of-illness studies can significantly contribute to a better understanding of the drivers and problems which lead to the increasing costs in heart failure. The aim of this study was to perform a systematic review of published cost-of-illness studies related to heart failure to highlight the increasing cost impact of heart failure. Methods A systematic review was conducted from 2004 to 2016 to identify cost-of-illness studies related to heart failure, searching PubMed (Medline), Cochrane, Science Direct (Embase), Scopus and CRD York Database. Results Of the total of 16 studies identified, 11 studies reported prevalence-based estimates, 2 studies focused on incidence-based data and 3 articles presented both types of cost data. A large variation concerning cost components and estimates can be noted. Only three studies estimated indirect costs. Most of the included studies have shown that the costs for hospital admission are the most expensive cost element. Estimates for annual prevalence-based costs for heart failure patients range from 868forSouthKoreato 25,532 for Germany. The lifetime costs for heart failure patients have been estimated to 126.819perpatient.ConclusionsOurreviewhighlightstheconsiderableandgrowingeconomicburdenofheartfailureonthehealthcaresystems.Thecost-of-illnessstudiesincludedinthisreviewshowlargevariationsinmethodologyusedandthecostresultsvaryconsequently.Highqualitydatafromcost-of-illnessstudieswitharobustmethodologyappliedcaninformpolicymakersaboutthemajorcostdriversofheartfailureandcanbeusedasthebasisoffurthereconomicevaluations.