OBJECTIVES: To assess the economic impact of the incorporation of the laparoscopic procedure in terms of costs, QALYs, reduction of the convalescence period and complication rates under the Brazilian public payer perspective. METHODS: An analytic decision-tree model was built to estimate costs and outcomes of the cholecystectomy surgery comparing the main differences between open and laparoscopic techniques (minimally invasive procedures), based on Brazilian guidelines for HTA (Vianna, 2007). LAP reduces the probability of nosocomial infection (NI) from 8.93% to 2.6% (Brill 2008), the length-of-stay (LOS) from 3 days to 1 day and return to work in 22.51 days (Keus 2006) when compared to OP. Only direct medical costs (physician fees, hospital length-of-stay (LOS) and materials were based on public lists (SUS/SIGTAP and SIMPRO, 2009). A panel of specialists was conducted to validate the model. One-month timeframe was considered, based on intra and post-operative periods; consequently a discount rate was not necessary. One-way sensitivity analyses were performed to assess the robustness of the results. RESULTS: In terms of outcomes, for each 1000 surgeries the LAP procedure can reduce the number of NI cases in 53, sepsis in 4 and deaths in 2. Total costs (including complications and devices) were higher R$ 2,271 for LAP than OP (R$3135 versus R$864), mainly because of laparoscopic devices’ costs (R$2385). However, LAP technique allowed the reduction on complication costs in 34% (from R$231 for OP to R$151 for LAP). Due to lower complication rates, LAP showed a 0.1085 higher QALY than OP (0.8357 for OP vs. 0.9443 for LAP). In the end, the incremental cost-utility ratio for the incorporation of the LAP procedure was R$20,920 per QALY. CONCLUSIONS: Findings suggest LAP approach to cholecystectomy as a safer and cost-effective choice for cholecystectomy surgery, under the Brazilian public system.