OBJECTIVES: To compare costs and outcomes of surgery techniques [open (OP) versus laparoscopic (LAP)] for colon rectal surgery in order to assess the impact on costs and clinical outcomes under the private payer perspective in Brazil. METHODS: A decision tree and a Markov model were developed according to the Brazilian guidelines for Health Technology Assessment (Vianna, 2007). Outcomes rates and probabilities for infection, mortality, conversion, survival, recurrence, sepsis and hernia were obtained from clinical literature (Gunnarsson 2008, King 2006, Bonjer 2009, Murray 2006, Brazilian consensus for Sepsis 2003). A panel of specialists was conducted to validate the model and capture the local practice. Only direct medical costs were considered (Sources: SIMPRO, 2009; CBHPM 5th edition). A lifetime perspective was taken and a discount rate of 5% was applied (Vianna, 2007). A probabilistic sensitivity analysis was performed to assess the robustness of the results. RESULTS: Lengh of staying (LOS) was 9 days for OP versus 6 days for LAP resulting in a reduction of hospital costs and medical staff fees (R$5687 OP versus R$4445 LAP). LAP also reduced the complication costs in 70% (-R$ 981 per procedure). Total costs were 8.52% higher for LAP than OP (R$22,085 vs. R$ 20,350), because of LAP’s devices costs (R$17,228 vs. R$13,270). In terms of outcomes, due mainly to the reduction of infection rate (OP 4.09% vs. 2.11% LAP) and the reduction of sepsis cases in 48.41% LAP showed an improvement on overall survival (1.31 years without discount and 0.36 years discounted). The sensitivity analysis showed that over 65% of the 5000 simulation were cost-effective. 1 USD = R$ 1.78 CONCLUSIONS: Findings suggest LAP as a safer and cost-effective choice for colon cancer surgeries when compared with OP.