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<b>Aims and objectives:</b> Refractory and unexplained chronic cough (RCC and UCC) necessitate frequent referral for specialist evaluations. This study provides data on healthcare resource utilisation and costs, which have previously been lacking. <b>Methodology:</b> This observational study enrolled adults with RCC or UCC attending a specialist clinic and included a control cohort, matched 1:5 for age, gender and smoking history. Primary and secondary care data were obtained for 5 yrs prior to and 2 yrs post initial clinic visit (index). The primary endpoint was total 5-yr healthcare cost to the UK NHS pre-diagnosis compared to controls. <b>Results:</b> 200 patients provided consent, 80 of whom had GP consent to access primary care data. Mean age at index was 62.2±11.4 yrs; 71% were female, 68% had never smoked. Mean symptom duration pre-diagnosis was 8.0±9.4 yrs. Mean cough severity score was 63.7±23.2 mm at index on a Visual Analog Scale, and Leicester Cough Questionnaire total score was 10.9±4.1. In the 80 patients with GP data, mean total cost over the 5 yrs pre-diagnosis was threefold higher (95%CI 2.3, 3.9) compared with controls (p<0.001). Most excess costs related to visits and procedures in secondary care. Mean secondary care costs over the 5 yrs prior to index in all 200 patients were 3.6 times higher than controls. Higher costs were associated with greater cough severity and impact on quality of life. RCC- or UCC-associated costs decreased post-diagnosis, but remained higher than controls. <b>Conclusion:</b> Before diagnosis, RCC and UCC patients have multiple investigations and treatments at significant cost. Resource utilisation was less after diagnosis, but remained higher than controls highlighting the need for targeted therapies.