OBJECTIVES: The borderline personality disorder (BPD) is a common mental disorder. It is frequently associated with various mental co-morbidities and causes a fundamental loss of functioning. Furthermore, economically relevant consequences such as high utilization of inpatient and emergency room treatment or reduced productivity at work have been reported. The aim of this study is to present the existing health economic evidence regarding BPD and to point out implications for further research. METHODS: We performed a systematic literature search in MEDLINE, EMBASE, PsycInfo and NHSEED to identify cost-of-illness studies (COI), cost-effectiveness analyses (CEA) and other cost studies (OCS) regarding BPD. Cost data were inflated to the year 2010 and converted into US-$ using purchasing power parities (PPP). Quality assessment of the studies was performed by means of a standardised quality checklist. RESULTS: We identified three COI, eight CEA and six OCS. The methodical quality was moderate. Depending on study perspective and considered cost categories cost per patient and year ranged from 18,306 US-$ PPP to 69,231 US-$ PPP. A co-morbid conduct disorder was reported to be the most influential factor for increased health care costs. All CEA analysed psychotherapy interventions. While CEA reporting cost per avoided parasuicide event indicated favourable incremental cost effectiveness ratios, CEA reporting cost per quality-adjusted life years (QALY) indicated just weak cost-effectiveness. CONCLUSIONS: BPD is associated with high costs. Available COI provide a first insight into the structure of cost and its predictors. There are no CEA regarding medication for BPD. Evidence regarding the cost-effectiveness of psychotherapy interventions is ambiguous. Future research should promote the understanding of the economic aspects of BPD and determine the societal value of its treatment. In this context high methodical standards are particularly important.