OBJECTIVES: Resource evaluation of intravenous patient-controlled analgesia to date has focused primarily on nursing or pharmacy staff time. Some have quantified IV-PCA related error costs but little data exists on estimated total costs from the hospital provider’s perspective. The objective of this study is to model IV‐PCA therapy costs in an inpatient, postoperative population.  METHODS: Cost model data were obtained by 1) survey of 140 hospital pharmacy directors (drug, IV-PCA pump-related and non-drug supply costs), 2)  Premier hospital research database analysis of 7 million surgical discharges from 2008-2011 (IV-PCA- related complications and cost, and length of stay adjusting for demographics, comorbidity and procedures) and 3) by systematic literature review (nursing/pharmacy staff time, IV-PCA related errors, delineation of IV-PCA-related tasks). Sensitivity analyses were conducted. RESULTS: Mean duration of IV-PCA in the Premier database per post-surgical inpatient was 1.7days. The mean cost per day of IV-PCA was $305.37 on day 1, and $264.13 on day 2.  Individual mean costs per IV-PCA day included pharmacy drug, $19.66/day; nursing labor, $38.13 on day 1, and $17.57 on day 2; pharmacy labor, $13.17/day; pump cost, $5.24/day; error-related costs, $19.71/day; and non-drug disposables, $21.56 on day 1, and $0.88 on day 2.  Costs of complications related to IV-PCA (DVT, PE, post-op pneumonia occurred in 2.1% of IV-PCA patients vs. 1.6% of non-IV-PCA patients) added $187.58 per IV-PCA day, with cost adjusted for baseline demographics and surgical procedure.  In addition to per IV-PCA day costs, analyses of Premier data indicate IV-PCA patients had a statistically significant  extended length of stay adjusting for baseline demographics and surgical procedures (mean LOS IV-PCA 4.53 [95% CI 4.41-4.66], LOS non IV-PCA 4.24 [95% CI 4.12-4.35]). CONCLUSIONS: IV-PCA, while a mainstay of post of post-operative pain management, is costly. Less resource intensive IV-PCA with fewer associated complications could be beneficial to hospitals.