OBJECTIVES: Estimate the clinical and economic outcomes of the surgical repair of anterior vaginal wall prolapse using Prolift® vs. colporrhaphy to assess its cost-effectiveness under a third level hospital perspective in Mexico.  METHODS: A multi-state Markov model was developed to assess the evolution of a patient with anterior vaginal wall prolapse under a conventional surgical repair strategy (colporrhaphy) and a mesh grant (Prolift®) after 2, 4, 10 and 20 years. A specialist panel was conducted to collect current clinical practice, resource utilization and complication data. After the first surgical prolapse repair, the base case patient could face two additional surgeries if prolapse relapsed. Two scenarios were modeled to compare the clinical and economic impact of Prolift® as second line treatment; the mesh grant was the assumed third line treatment for both scenarios. The effectiveness variable was the objective recurrence (failure) rate. Clinical data, transition probabilities and mortality rates were taken from published sources. Only direct medical costs were considered, and cost data was retrieved from IMSS official cost list. The price of Prolift® was internally estimated. Results are expressed as 2010 inflation-adjusted Mexican pesos (MXN) and MXN/QALY for ICERs. A 4.5% discount rate was used for costs and outcomes. RESULTS: Total costs for year 1 were higher for the Prolift® strategy ($75,688 vs. $74,544), but yielded an overall 22% complication reduction. For year 2, total costs were lower for Prolift® ($81,675 vs. $104,007), yielding better outcomes (0.04 incremental QALYs), thus being a dominant strategy (-$528,682/QALY). For the following years, Prolift® showed to be a consistent cost-saving alternative vs. colporrhaphy: ICERs for years 4, 10 and 20 were -$273,598/QALY, -$29,942/QALY and -$1,212/QALY. CONCLUSIONS: Findings suggest Prolift® is a safe and cost-effective alternative to treat anterior vaginal wall prolapse when compared to colporrhaphy. Savings are due to lower failure and complication rates.