OBJECTIVES: The burden and cost of liver disease is known to be substantial, but accurate data on this subject is still scarce in Portugal. So far most estimates are obtained from diagnosis-related groups (DRGs) associated with hospital financing and from expert panels. In this analysis we aimed to calculate the real costs associated with hospital admissions due to liver cirrhosis (LC) in a large hospital. METHODS: All hospitalizations in the gastroenterology department from a tertiary hospital in Portugal (Centro Hospitalar Lisboa Central) during 2012 were analyzed. Patient level data was used to retrieve relevant demographic and clinical information. Costs assumed to be specific for LC admissions, namely medication, imaging and other techniques, were estimated directly. Department-specific hospital accountancy was used to include the remaining hospital costs associated with these hospitalizations.   RESULTS: A total of 644 admissions were analyzed, from which 135 (21.0%) were due to LC, corresponding to 82 patients. 74.4% (n=61) were males, median age was 55 years. The main cause of LC was alcohol (58.5%). In the admissions due to LC, average length of stay (LoS) was 15.3 days and total mean hospitalization cost was 3,979.5€. For all analyzed admissions, average LoS and mean total cost were 8.1 days and 2,323.8€, respectively. Average cost for medications in admissions for LC amounted to 492.7€, compared to 228.7€ for all admissions. Within admissions for LC, costs were not significantly different for hospitalizations with or without hepatocellular carcinoma. CONCLUSIONS: The estimated overall cost of a hospital admission for LC in a gastroenterology department was superior to the average value of hospitalizations for all causes, and approximately twice the official DRG value. This study highlights the current economic burden of liver cirrhosis faced by a tertiary hospital and the possible need to revise some of the assumptions used for financing Portuguese hospitals.