OBJECTIVES: This review was conducted to assess the economic burden of pancreatic cancer (PC) in Europe. METHODS: Systematic search of Embase® and MEDLINE® databases was conducted from January 2002 to June 2012 to identify economic studies on PC in Europe. English language studies, regardless of design and intervention were included. Eligibility of trials was assessed by two reviewers with any discrepancy reconciled by a third, independent reviewer. RESULTS: Of the 97 retrieved citations, seven met pre-defined inclusion criteria. Four studies were cost-analyses while other three were cost-minimisation, cost-utility, and cost-benefit analysis, respectively. In Europe, the predicted PC mortality varied between 6.6-8.2/100,000 men and between 4-5.7/100,000 women in 2012. In Sweden, the direct costs/patient/month associated with PC rose from €1578 in 2001 to €3103 in 2002-2005 and then to €6590 in 2009. In 2009, the major contributors of this direct cost were hospitalisations (€4670), surgery (€719), and chemotherapy (€258). The mean total cost of illness/patient for PC in Germany was €31,375 (cost years 2000-2003), where direct cost was responsible for 90% of this total value and the remaining 10% was contributed by indirect costs including loss of productivity due to days-off work. In 2009, the estimated cost/patient associated with loss of productivity due to absenteeism was €6077 in Sweden. Upon assessment of curative resection cost for PC per patient in Sweden, it was found to be about €39,000 in 2009. The mean costs per patient associated with the use of diagnosis of PC were $1925 in Switzerland (2004), $1249 in Spain (2001), and €1545 in Sweden (2001). CONCLUSIONS: Although limited data is available, a trend in increase of fiscal burden of PC was observed. The major contributors of this burden were surgery, hospitalisations, chemotherapy, and loss of productivity. Therapies that prevent or delay disease progression could reduce this burden.