OBJECTIVES The aim was to determine the cost-effectiveness of colonic stent insertion for the management of malignant bowel obstructions. Colonic stents are a minimally invasive alternative to open surgery for patients medically unfit for single stage surgery. METHODS Two economic models were developed. The first compared patients who received palliative or definitive stents and were not medically fit for re-anastomosis. The second compared patients who received stents as a bridge-to-surgery and were medically fit for a second stage of two-stage surgery, this included colostomy or Hartmann’s procedure. RESULTS For patients requiring palliation, the cost of colonic stent insertion was estimated to be $17,809 compared to $20,516 for palliative colostomy (a saving of $2,707). The benefits associated with both procedures were 0.099 QALYs and 0.089 QALYs gained, respectively, an incremental benefit of 0.01 QALYs per patient. For patients requiring a bridge-to-surgery, the cost of colonic stent insertion was estimated to be $29,729, compared to $30,169 for patients that received multi-stage surgery (either a colostomy or a Hartmann’s procedure). This represented a cost savings of $440. The estimated average patient would gain 0.510 QALYs compared to 0.458 QALYs in the multi-stage surgery group. This yields an incremental benefit of 0.052 QALYs per patient. The main drivers of both models were the technical and clinical success of the stent insertion, and length of hospital stay following the procedures.  The probability of a resection with primary anastomosis after insertion of a stent and the cost of stenting were also drivers in the bridge-to-surgery model. CONCLUSIONS In terms of cost-effectiveness, colonic stent insertion for malignant bowel obstruction in patients requiring palliation or a bridge-to-surgery dominated the current alternative surgical procedures.