OBJECTIVES: To assess the cost-effectiveness of the anterior repair of the Pelvic organ prolapse (POP) with Prolift® versus the colporrhaphy (COLP), under private payer perspective, in Brazil. METHODS: A multi-state Markov model was developed to assess the evolution of a patient with anterior vaginal prolapse after COLP and Prolift® after 2, 4, 10 and 20 years. A panel of specialist was conducted to obtain the local practice and to collect the complication rates. Only direct medical costs were considered (SIMPRO, 2010; CBHPM 5th Ed). Clinical data, transition probabilities and mortality rates were taken from published sources (IBGE, 2008; Jia, X 2007). The base case patient could face up to three surgical repairs if prolapse relapsed. Two scenarios were modeled to compare the clinical and economic impact of Prolift® as second line treatment; mesh grant was the assumed third line treatment for both scenarios. Discount rate of 5% for costs and outcomes was taken following the Brazilian HTA guidelines (Vianna, 2007). One-way sensitivity analysis was conducted to assess the robustness of the results. RESULTS: The total costs for the first year were higher for Prolift® (R$8119 versus R$4777; incremental R$3342). For the 2nd year the difference in the total costs reduced (R$8659 vs R$7435; additional R$1223) with better outcomes for Prolift® (incremental QALYs: 0.04) with ICER ranging from R$19,099 (non discounted) to R$33,207 (discounted). For the next years the ICERs reduced, showing long term benefits of the adoption of Prolift®. For the fourth year ICER ranging from R$419 to R$532, 10th year from R$578 to R$827 and for the 20th year ranging from R$832 to R$1291, for non discounted and discounted results. CONCLUSIONS: Findings suggest Prolift® as a cost-effective intervention, under the Brazilian private payer perspective.