The direct cost to the NHS of pars plana vitrectomy (PPV) is unknown since a bottom-up costing exercise has not been undertaken. Healthcare resource group (HRG) costing relies on a top-down approach. OBJECTIVES: To quantify the direct cost of PPV for vitreomacular traction (VMT), epiretinal membrane (ERM) and macular hole (MH). METHODS: Each of five NHS vitreoretinal units recorded the indication for surgery and all procedure elements for a minimum of 30 consecutive PPVs, to include at least 10 cases of VMT, ERM, or MH. In-surgery bottom-up costing was undertaken by prospectively recording all consumables, equipment and staff salaries associated with surgery, between March and September 2012. Out-of-surgery costs, namely before and after surgery between admission and discharge, were estimated based on accounting costs recorded in one site. RESULTS: Of 151 PPVs, 57 were for MH (16.6%), ERM (15.2%), or VMT (4%). The average surgical time was 1.22 hours [range 0.96-1.38], corresponding to an average staff cost of £280.40 [£184.90-£376.70]. The average cost of consumables was £534.60 [£406.55-£688.85], and of equipment £87.75 [£28.10-£139.15]. The average direct cost of PPV in theatre was £901.10 [£671.00-£1185.55]. Average out-of-surgery costs were estimated at £325.35, including nursing staff, extra consumables and hospitalisation costs. This resulted in a total cost of £1673.80 [£1496.40-£1863.30], including 30% overheads. This cost estimate is considered an under-estimate because of lack of available data on departmental-level general costs, medical and anaesthetic staff costs incurred out-of-surgery. The average effective HRG tariff reimbursed was £1701.20. CONCLUSIONS: These figures indicate that the real cost incurred is likely to be higher than the reimbursed tariff, but it may be cost-effective for NHS hospitals to undertake additional PPVs for VMT, ERM and MH, if they can amortise existing infrastructure with a sufficient number of interventions to benefit from economies of scale.