OBJECTIVES: Gout, a chronic inflammatory arthritis, can result in extensive medical problems due to painful flares and joint damage resulting from the build-up of tophi (deposits of uric acid crystals). The prevalence of gout is rising, which is likely to increase the burden of the disease. We determined the current cost impacts of gout and identified key disease burden factors. We also aimed to highlight data gaps for further investigation. METHODS: A systematic literature review was conducted using the MEDLINE database and The Cochrane Library. Articles published in English between January 2000 and July 2014 that reported the economic burden (in terms of either direct or indirect costs) were identified, and patient and cost data were collated, with key themes and data gaps identified. RESULTS: Of the 323 studies identified, 13 primary studies were relevant to the economic burden of gout. Key variables included serum uric acid levels, presence of tophi and number of flares, which resulted in high healthcare resource use that was frequently attributed to hospitalisation and inpatient stay. The incremental direct cost of gout was reported to be up to US$21,467 per annum, in cases where patients were experiencing regular acute flares with the presence of tophi. CONCLUSIONS: Patient-level costs associated with the treatment and clinical management of gout can be substantial, depending on disease severity. The identified studies were dominated by direct cost analyses; only three studies specifically considered indirect costs. There was a paucity of non-US data, and there was a lack of published studies estimating the population-wide cost. Despite the limited published data, the review identified a growing number of publications in this area in the last 5 years, suggesting healthcare decision makers’ increasing awareness of the wider impacts of gout.