OBJECTIVES: In Italy the recent update of the DRG system has led to evaluate the effect on the diffusion of new therapies. The Interspinous Process Device (IPD) implantation represents an innovative strategy for different degenerative spinal pathologies with potential clinical and economic advantages. The aim of this study is to evaluate the hospitalization costs for IPD procedure according to a micro-costing approach and to compare it with current regional DRG tariffs. METHODS: The project, conducted from the hospital perspective, is performed in one pilot centre (Varese hospital), regional benchmark for this kind of procedure in which learning curve is considered completed. The cost analysis is based on the clinical pathway drawn up from the information provided by the medical team. Resource use including staff time, diagnostic tests, drugs, consumables and technology equipment utilization are collected from interviews to the team. Operating room costs, administrative and general costs and follow up hospital resource consumption are derived from hospital accounting data. Unit costs are collected either from hospital accounting or regional tariffs for specialist services. RESULTS: The total average cost estimated for a patient submitted to an IPD implantation is €5644, with an average LOS of 2.7 days. The average cost for the implantation of 1 IPD is € 4515, value assigned to increase to €7087 for multilevel approaches with the implantation of 2 devices in the same procedure (42% of cases). Excluding general costs and the number of IPDs implanted, the main key cost driver are consumables and devices (62%), and operating room costs (16%). CONCLUSIONS:   The regional tariff of the DRG related to this procedure (Lombardia Region, DRG 500, version 24) does not cover the hospitalization costs estimated, especially for the multilevel approaches. This leads to consider the effects of current reimbursement on the adoption of innovative therapy.