OBJECTIVES: Establish the potential resource and cost savings from using ePTFE covered stent-grafts configured for TIPS (SG) compared to bare metal stents (BMS). Most centres have adopted SGs to treat portal hypertension because of their reduced re-intervention rates, elimination of regular monitoring of patency and improved survival. However there is no published economic analysis identifying the related cost consequences. Understanding the improved efficiencies is essential in the current financial environment. METHODS: A Markov economic model was developed to measure the incremental costs of the initial procedure and re-interventions with SG compared to BMS. Re-intervention procedures included angioplasty (67%), introducing a balloon expandable stent (22%) or a second stent (10%). The adverse events were hepatic encephalopathy and clinical relapse. Clinical data came mainly from a published RCT (Bureau 2007), whilst healthcare costs were from UK national databases. RESULTS: Compared to BMS, using SG in TIPS resulted in a cost saving of over £1,150 per patient over 2 years. Modelling 100 patients, compared to BMS, the SG cohort had 25 fewer re-interventions including angioplasties, saving 41 hours staff time in theatre and 16 inpatient days; with fewer cases of encephalopathy (16), recurrent ascites (8), variceal bleeds (5) and a markedly reduced mortality (13). CONCLUSIONS: The model showed that ePTFE covered stent-grafts configured for TIPS reduced mortality and re-interventions, saved theatre time and bed-days, and reduced overall costs despite the higher initial device cost.