OBJECTIVES: To describe the management of patients with malignant ascites and to evaluate resource consumption and associated cost from the hospital provider’s perspective in a pilot study. METHODS: A cross-sectional, retrospective pilot study was performed at hospitals of maximum medical care in Germany. Resource consumption data for e.g. number of paracenteses, length of hospital stay, diagnostics and drugs were obtained by patient chart abstraction. Direct medical cost was calculated. RESULTS: In total, 27 patients with 94 hospital stays were included in the analysis (mean age 63 years, standard deviation [SD] 15; 56% male, mean Karnofsky index 54% SD 25). The most common underlying malignancies were gastric carcinoma (26%), pancreatic carcinoma (15%) and colon carcinoma (11%). Mean number of therapeutic paracenteses per patient was 4.5 (SD 3.8) within the time period from ascites diagnosis to death. Mean length of hospital stay was 5.5 days (SD 8.0). Medication mainly comprised human albumin (64%), diuretics (20%), antibiotics (5%) and cytostatics used for intraperitoneal chemotherapy (3%). Mean direct cost per patient and per hospital stay was €738 (SD1258) and €1011 (SD1584) per hospital stay with paracentesis as reason for admission. Mean cost per patient was €2540 (SD 2808). If cost calculation is based on unit cost for German university hospitals, costs were 18% higher. Main cost driver was the hospital stay (60% of costs). CONCLUSIONS: Management of malignant ascites varies with respect to in- or outpatient paracentesis, number of paracenteses, and concomitant medication. More data are needed to optimize management and identification of cost effective therapeutic options. In the field of palliative care investigation of resource consumption and costs is challenging since the needs and quality of life of the patients should always be taken into consideration.