OBJECTIVES: Costs related to Magnetic Resonance Guided Focused Ultrasound (MR-HIFU) for uterine fibroids have not been compared to alternative treatments being performed in Germany up to now. Hence, the purpose of this analysis was to identify the cost-consequences of hysterectomy, myomectomy, uterine artery embolization (UAE) and MR-HIFU in the first year of therapy. In addtition the budget impact of the MR-HIFU from the perspective of the NHS (direct costs) and social perspective (indirect costs) should be analysed. METHODS: The cost of leiomyoma-related hospitalization and patient follow-up was calculated based on data from statistics of the Hospital Remuneration System, the G-DRG hospital payment scheme and the office-based doctors’ fee scale. The cost caused due to recovery and disability was estimated based on information from the Federal Statistical Office and data of the Federal Health Reporting. Experts were interviewed to provide follow-up resource use information. RESULTS: A total of 78,229 hospitalized leiomyoma-related cases were treated in year 2009. 80% were hysterectomies, 14% myomectomies and 6% were related to other therapies. Concerning the therapy cost per patient, hysterectomy reveals the highest therapy cost, (€5913) followed by myomectomy (€5793), UAE (€4675) and MR-HIFU (€4311). In a scenario without MR-HIFU the cost per case accrued to a total of €5840. The budget impact analyse targeting a patient group between 30 and 45 years of age, reveals a potential cost-benefit of €1529 per patient if MR-HIFU would be introduced in the SHI system. CONCLUSIONS: Our results suggest that MR-HIFU due to the administration in the outpatient sector, the low complication rate and the low disability cost should be considered as a cost-favourable alternative for the therapy of uterine fibroids.