There is some evidence that the annual number of patients diagnosed with anal cancer in the UK is increasing. Such a rise could potentially have important health and economic consequences. OBJECTIVES: To estimate hospital treatment costs for anal cancer in England, based on data from the HES database, as part of a wider study investigating the total economic burden of anal cancer in the UK. METHODS: Inpatient admissions for anal cancer between the years 2006/07 to 2010/11 were retrospectively analysed. Data was obtained from HES, a database covering English hospital activity, with inpatient episodes aggregated into spells of care associated with a specific Healthcare Resource Group (HRG). The HRGs were linked to costs from the UK National Tariff in order to calculate the average annual and per inpatient payments for treatment of anal cancer, as per the NHS Payment by Results framework. Where necessary, costs were supplemented by expert opinion and other published cost estimates. A limited amount of HES data on outpatient consultations was also collected and analysed. RESULTS: In England, the average annual payments for inpatient care associated with anal cancer are estimated to total £7,754,219 (males = £2,930,360, females = £4,823,859). This translated to a mean annual cost per inpatient of £4,605 and £5,232 for males and females respectively. Outpatient costs were lower across both genders with annual payments for outpatient care estimated at £184,479 for males and £286,686 for females. This is likely to be a significant underestimate due to coverage issues with the HES outpatient dataset on account of local variation in the sources of funding for certain treatments. Further research into outpatient costs is currently ongoing. CONCLUSIONS: Despite the significant underestimation of the outpatient costs, these results suggest anal cancer places a significant health and economic burden on the English NHS.