OBJECTIVES: Endometrial ablation has emerged as a minimally invasive alternative to hysterectomy for pre-menopausal patients suffering from menorrhagia. Less invasive ablation procedures include thermal balloon endometrial ablation using GYNECARE THERMACHOICE® III (Ethicon, Inc.), and radio-frequency endometrial ablation using NovaSure® (Hologic, Inc.). This study compares costs of achieving desired treatment outcomes with Thermachoice versus Novasure ablation techniques. METHODS: A value analysis model was developed to estimate the cost-per-patient treated with either device – overall, and for achieving desired treatment outcomes of ‘amenorrhea’, ‘return to normal bleeding’, and ‘patient satisfaction’. Subsequent hysterectomy was also modeled as a failure outcome. Costs were included for the ablation device, disposables, operating room (OR) time, and subsequent hysterectomy. Capital expenditure for controller was included for Thermachoice, but not for Novasure, to represent a best possible scenario for Novasure. Analysis was performed from a hospital buyer perspective, over 1- and 3- years following initial ablation procedure. Sensitivity analyses were conducted by forcing reductions in clinical effectiveness and simultaneous increase in subsequent hysterectomy for procedure with lesser costs in the base cases. RESULTS: 100 hypothetical patients underwent each procedure. Overall cost-per-patient was lower for Thermachoice over both 1 and 3 year timeframes – offering a saving of about 4% compared to Novasure. For specific outcomes, savings were between 6.9% for ‘patients achieving amenorrhea’ to 7.8% for ‘patients returning to normal bleeding’ in 1 year and between 3.8% and 4.8% for all outcomes in the 3 year scenario. Sensitivity analyses showed that Thermachoice continued to offer savings in overall cost-per-patient compared to Novasure even with a reduction of all effectiveness outcomes and increase in subsequent hysterectomy rates by about 50% and 18% in the 1- and 3-year scenarios. CONCLUSIONS: In our model, endometrial ablation with Thermachoice offered cost savings – compared to Novasure, in achieving desired short and long term treatment outcomes.