OBJECTIVES: Ipilimumab is the first drug to be licensed in Italy for the treatment of advanced melanoma in adults who have received prior therapy. This study aims to estimate the budget impact of ipilimumab in patients who live in the Veneto Region. METHODS: Our analysis was performed from the perspective of the Italian health care system. Two scenarios were analyzed: one with the optimization of vials and the other without. Only drug acquisition costs (measured in euro) were considered into the analysis. All costs were referred to year 2013. RESULTS: Based on the incidence and mortality rates of the last three years, a total of 80 adult patients were assumed to be elegible for the treatment in the Veneto Region. The cost per mg of ipilimumab was €53,70: one 10 ml vial contains 50 mg of ipilimumab and one 40 ml vial contains 200 mg of ipilimumab. The recommended induction regimen is 3 mg/kg administered intravenously every 3 weeks for a total of 4 doses. The costs per patient of one year’s therapy with ipilimumab ranged from €45.108 with vial optimization (considering 4-5 patients infused at the same time - average weight 70 kg) to €53.700 without. The Veneto Region identified a single center for the preparation/administration of treatment to minimize drug waste and to reduce the yearly treatment cost per patient, with a saving of €8.592 per patient/year. Applied to whole elegible patients (average weight 70-75 kg), it allows to obtain savings up to €430.000-690.000 per year.  CONCLUSIONS: High prices for new cancer drugs are a growing concern to payers, given the large number of cancer drugs in development and the limited health care resources. Vial optimization may be an useful strategy to decrease waste, maximizing the use of health care resources and ensuring that eligible patients are treated.