OBJECTIVES: The objetive of this paper is an analysis of cost effectiveness of a proposed clinical pathway for the surveillance of hepatocellular carcinoma in Colombia compared to conventional management METHODS: Economic evaluation is performed by designing a Markov model to simulate two cohorts, one under a surveillance program through the combined use of alpha-fetoprotein and ultrasound every 6 months and another with the current monitoring scheme with a time horizon of 30 years and age of onset of 30 years, a rate adjustment of 3% the initial cohort of 100 patients RESULTS: The cost in the surveillance group is US $ 1,495.548 and unguarded arm is U.S. $ 798,714. With the surveillance program presents 21 deaths caused by the disease compared with 35 deaths without monitoring program, with 688 years of life gained and an ICER of US$ 670. As demonstrated in other studies, the performing monitoring for HCC reduces mortality in the population at risk. The clinical pathway implementation of surveillance for HCC in people with liver cirrhosis and HBV and HCV infection is very cost effective compared with doing nothing from the perspective of third-party payer in Colombia. The results maintain the cost-effectiveness in the sensitivity analysis without major changes. CONCLUSIONS: The implementation of a monitoring method with alpha-fetoprotein and ultrasound every two years is cost effective. We recommend the implementation of clinical pathway assessed for its cost effectiveness in the light of life years gained as outcome.