OBJECTIVES: The increasing use of both PET scan and surgical lymph node evaluation in the cervical cancer (CC) treatment has led to a clinical debate. The objective of this study is to provide a cost analysis of routine PET imaging in the work-up of CC. METHODS: A decision-tree model was designed to compare pre-treatment evaluation including PET-scan versus FIGO staging. Primary outcome was correct primary treatment (CPT) due to the use of PET or FIGO. Cost effectiveness ratios were calculated and results were expressed in terms of incremental cost effectiveness ratio (ICER). The model used the SEER 2011 database (n=12,200), for number, incidence, and stage distribution of CC. Medicare reimbursement rates were used for costs. Lymph node metastasis rates for each stage, and performance characteristics of PET were abstracted from published data. Cited values were used and varied over for sensitivity analysis. RESULTS: The addition of PET-scan to FIGO clinical staging for IA1 CC resulted in 6(0.5%) more CPTs than FIGO staging at baseline. In stage IA2, 75(6%) more CPT were performed and 187(14%) in stage IB1, and an additional 322(24%) in IB2. In stage IIA, PET-scan resulted in an additional 50(3%) CPT (ICER=$75,575), compared to 234(12%) CPT (ICER=$61,509) in stage IIB, and 333(26%) additional CPT in stage IIIA, (ICER= $48,293). In stage IIIB and IVA the addition of PET resulted in 240(19%) more CPT, and 41(8%) additional CPT in stage IVA (ICER=$52,791 vs.$71,810). Outcomes were sensitive to changes in prevalence and PET performance in the sensitivity analysis. CONCLUSIONS: Routine pre-treatment PET-scan may be cost effective for stage IA2-IB2 CC. The inclusion of PET-scan in the pre-treatment evaluation of stage I CC increased the number of CPT with an elevated ICER. The findings of this model need to be validated in the clinical-setting to generate knowledge on best resources’ allocation.