Annual mortality and hospital admission costs for acute rheumatic fever and rheumatic heart disease were estimated from hospital admissions in 2000-2009 and deaths in 2000-2007. The mean annual mortality rate was 4.4 per 100,000 (95% CI 4.2 to 4.7) based on an average of 159 deaths from rheumatic heart disease each year. Māori and Pacific mortality rates were 5- to 10-fold higher than for non-Māori/Pacific people. They also died from rheumatic heart disease at a much younger age: mean age at death (male/female) was 56.4/58.4 years for Māori; 50.9/59.8 years for Pacific; and 78.2/80.6 years for non-Māori/non-Pacific men and women. Hospital admissions for rheumatic fever or rheumatic heart disease were estimated to cost $12 million per year (based on 2009/2010 national pricing). Heart valve surgery accounted for 28% of admissions and 71% of the cost. For children 5-14 years of age, valve surgery accounted for 7% of admissions and 27% of the cost. Notably, two-thirds of the cost occurred after the age of 30 years.