OBJECTIVES: To assess the cost of percutaneous pulmonary valve implantation (PPVI), a new procedure introduced in 2000 as a less invasive treatment for right ventricular outflow tract (RVOT) dysfunction, and the cost of surgical valve replacement in patients with right ventricular outflow tract dysfunction using a cohort simulation model. METHODS: A cost analysis was performed from the perspective of the purchaser (the UK NHS). The cost of PPVI was estimated using data based on a total of 141 patients who had undergone PPVI from 2000 to 2008. The cost of surgical valve replacement in a similar group of patients was estimated using a cohort simulation model populated with data drawn from the literature and expert opinion, given that PPVI has supplanted this procedure in the clinical setting analysed. The model is a cohort simulation model and assesses the cost of  surgery using a hypothetical population of 1000 individuals with right ventricular outflow tract dysfunction starting when their first valved biological conduit was surgically placed and following them for a period of 25 years assuming that 1) PPVI is not available as an option, and 2) that PPVI is available for those eligible for it. RESULTS: The model resulted in an estimate of mean cost per patient of £5276 in the absence of PPVI and in an estimate of mean cost per patient of £7958 in the presence of PPVI over the 25 years period of analysis. CONCLUSIONS: PPVI although more costly than the surgical alternative, it appears to delay surgery thus having a significant impact on the health and the quality of life of this patient population. More research is needed to quantify the magnitude of the impact on the quality of life and to assess the role of modelling generally in assessing costs and effects in medical devices.