Heartwater is a dangerous tick-borne disease for livestock farmers in South Africa and results in annual economic losses for the livestock industry. This study determined the total economic impact of heartwater in South Africa by calculating this disease's direct and indirect costs. Survey data from 272 livestock farmers from six provinces of South Africa was used for this study. Available heartwater research in South Africa only focused on the prevention and control of and vaccination against heartwater, with no research having undertaken an in-depth study of the total economic impact of this disease. The highest cost due to heartwater at provincial level was calculated for the Eastern Cape Province, followed by the North West and Mpumalanga Provinces. Heartwater has an enormous impact on the cattle industry, with an approximate R1 059 million losses experienced each year. The sheep industry experiences a total cost loss of approximately R168 million per year, with the goat industry experiencing about R39 million per year. The total economic impact of heartwater on the South African livestock industry is estimated at R1 266 million per annum. The direct cost contributed 66.47%, and indirect costs contributed 33.57% to the total cost of heartwater. The annual cost of heartwater vaccines contributed the least to the total cost of heartwater, with only 10% of the participants administering the heartwater vaccine. A total of 84.29% of the respondents indicated a need for a new and improved heartwater vaccine. This study emphasises the importance of heartwater in South Africa and farmers' high costs because of this disease. If an improved heartwater vaccine can be developed, the direct cost of heartwater will reduce, which is the bulk of its economic impact. This research can serve as a basis for future research on heartwater, where cost-benefit analyses could be conducted on heartwater's different prevention and control methods.