OBJECTIVES: To systematically identify economic evaluations of treatments recommended for chronic idiopathic urticaria (CIU) and studies reporting health-state utility weights and/or estimates of resource use and costs. METHODS: Systematic searches of MEDLINE, MEDLINE-In-Process, EconLit, EMBASE, the Cochrane Library, and conference abstracts were conducted from 1 January 2000 to 20 December 2011. Inclusion criteria considered studies reporting utility weights, resource use, costs, and/or economic evaluations of treatments in CIU patients older than 12 years. RESULTS: From 266 retrieved records, 3 studies were included: 1 economic evaluation of levocetirizine and 2 cost studies. The economic evaluation was a pooled analysis of two clinical trials comparing levocetirizine with placebo and incorporating productivity losses defined as absenteeism and/or presenteeism. One cost study reported total annual per-patient direct costs of $1,762; the other study reported a cost range between $1,290 and $2,419, depending on disease severity. Cost components included prescriptions, visits, hospitalisations, and laboratory costs. Annual per-patient indirect costs, defined as disease-related loss of earnings, were between $213 and $484, depending on severity. Although no utility studies in CIU were found, one study demonstrated that CIU severely impairs health-related quality of life at the same level as skin conditions, such as psoriasis and atopic dermatitis, on certain dimensions. CONCLUSIONS: This review identified limited evidence on costs, only one economic evaluation, and no utility data for CIU. Lacking comparative data, it is impossible to conclude what the most cost-effective treatment in CIU might be. Due to discrepancies between the cost studies, it is difficult to conclude which cost component contributed the most; however, one study reported that productivity loss was a major component. This review highlighted the substantial cost burden and a humanistic burden, comparable to other skin disorders, of CIU. Further research in this area is needed.