OBJECTIVES: Patients with COPD in their final months of life place a potentially high burden upon healthcare systems. The aim of this systematic review was to describe the resources used and costs incurred by patients with COPD at the end-of-life. METHODS: We performed a comprehensive literature search in Medline, Web of Science and Econlit and evaluated and synthesized existing evidence on resource use and costs at the end-of-life in COPD patients. We screened 886 abstracts and reviewed 80 full-text manuscripts. Inclusion criteria were at least one type of resource use and/or cost outcome reported in adults diagnosed with COPD during an end-of-life period (varying between 3 years and 2 weeks before death). Subsequently, we performed quality appraisal consistent with the ISPOR checklist for retrospective database studies and accomplished comprehensive data extraction. RESULTS: Nine studies fulfilled the inclusion criteria. Two, five and two studies described a European, North American and Asian healthcare setting, respectively. All studies had a retrospective design and were published between 2006 and 2014. We observed a very variable use of healthcare resources. An increased number of hospitalizations, ICU stay, primary care consultations and medication prescriptions and a lack of utilization of formal palliative care services were found to be the key drivers of resource use and costs of COPD patients during end-of-life. Palliative care also had a positive impact on costs in those patients. CONCLUSIONS: Despite a small number of existing studies, we found that the extensive and variable resource use and related costs of COPD patients during end-of-life applies to different aspects of the healthcare system. Especially the use of palliative care services is presumed to be effective in cost reduction at the end-of-life.