OBJECTIVES: Stapled haemorrhoidopexy (SH) offers several benefits over conventional excisional haemorrhoidectomy, which makes it attractive to patients with symptomatic prolapsing piles, yet its provision remains disparate. A full economic evaluation of stapled haemorrhoidopexy was undertaken to establish its cost effectiveness and take into consideration recent literature on clinical outcomes to show that the SH procedure can become cost-saving compared to CH (conventional haemorrhoidectomy). METHODS: A cost–utility analysis was undertaken to compare the use of SH with CH.The analysis used a probabilistic, cohort-based decision tree within a 1-year time-horizon. Costs were analysed from hospital and UK NHS perspective and utility was calculated using Quality Adjusted Life Years (QALY). Sensitivity analyses were used to show how variation in the clinical parameters affects cost effectiveness. RESULTS: The decrease in time in the operating theatre and shorter hospital stay with SH led to a cost saving of £27 per procedure compared to CH on a hospital level. From the NHS perspective the total treatment costs inclusive of the cost of recurrent prolapse, led to an incremental cost of £33 after one year. Calculation of QALYs induced an incremental QALY of 0.0076 and showed an ICER of £4,316, which is a highly cost-effective result. Sensitivity analysis taking into account recent publications showed that the SH procedure becomes cost saving with a reduction in recurrence rate of prolapse from 10% to 5% or a 50% reduction in re-surgery rate.   CONCLUSIONS: Stapled haemorrhoidopexy is a cost effective procedure with an incremental cost effective ration (ICER) of £4136. Furthermore the analysis also showed that stapled haemorrhoidopexy could even be cost-saving in UK clinical practice. This economic analysis, in line with the 2007 NICE guidance, supports its widespread implementation.