OBJECTIVES The aim of this study was to evaluate the use of services and costs related to agitation and containment of adult patients admitted to a psychiatric hospital. METHODS Systematic review through searches of Pubmed, CINHAL and Web of Knowledge (using a wide variety of terms related to agitation; inpatient care and use of services/costs); bibliographic references in retrieved studies and expert consultation. Studies published since 1998 were selected in duplicate by reviewing abstracts and full-text papers. RESULTS After removing duplicates, 372 papers were reviewed and 11 included in the review. Four studies were of high quality, 4 of moderate-high to moderate-low quality and three of low quality. Eight of the studies evaluated the impact of agitation on the length of stay and 6 showed that it was associated with longer stays. Four studies evaluated the impact of agitation on readmission and showed a statistically significant increase in the probability of readmission of agitated patients in comparison with non-agitated patients. Two studies evaluated medication, one showed that the mean medication dose was higher in agitated patients and the other found higher costs of treatment compared with non-agitated patients in the unadjusted analysis. Another estimated the costs of conflict and containment related to acute inpatient psychiatric care in UK. The total annual cost in England for all conflict was £72.55 million (£145,177 annual conflict cost per ward) and £106 million for containment (£212,316 annual containment cost per ward). CONCLUSIONS Studies on use of services and costs of agitation are scarce. Overall, agitation has an effect on healthcare use and costs in terms of longer length of stay, more readmissions and higher consumption of drugs. The average quality of the studies was moderate. Further research is needed to establish the degree of burden of agitation and containment borne by hospitals and the healthcare system.