OBJECTIVES: Persistent air leaks after lung resection surgery often lead to increased complications. A PEG hydrogel sealant (PleuraSeal™) is used as an adjunct to standard closure of pleural air leaks and has demonstrated shorter hospitalizations (1.7 fewer days; Wain JC et al, 2008, Conference Abstract) when compared with standard of care (e.g. staples and sutures alone). Our study was designed to estimate the potential cost offsets for using PleuraSeal™ in 100 hypothetical patients with an air leak using the cost offset from shorter hospital stays balanced against the cost for PleuraSeal™. METHODS: We assumed the cost for PleuraSeal™ in Italy to be €420 per treatment applied to all 100 hypothetical patients compared with no added cost for standard of care. We then balanced the cost for PleuraSeal™ with the reduction in hospital days and subsequent costs (€337/ thoracic ward day, A Brunelli et al, 2007), then calculated the potential cost offset for PleuraSeal™. RESULTS: An Italian hospital that performs 100 lung resections with air leaks can expect to save €15,300, or approximately €153 per patient when compared to standard of care as patients who had air leaks stayed in hospital an average of 1.7 days longer than those without air leaks. CONCLUSIONS: The cost for PleuraSeal™ is completely offset by the shorter length of hospital stay compared with standard of care in Italy. PleuraSeal™ is a compelling option for Italian hospitals that perform lung resection surgeries as the cost of the treatment is completely offset by the reduction in air leaks and subsequent shorter hospital stay.