OBJECTIVES:  To estimate the budget impact of ulipristal acetate 5mg (UPA) in the pre-operative treatment of uterine fibroids (UF) within a 3-year time horizon in France, by analyzing a national hospital database. METHODS:  The “Programme de Médicalisation des Systèmes d'Information” (PMSI) database is a comprehensive and exhaustive database on hospital stays in acute care facilities in France. These hospitalizations are mostly overnight stays, but also include day care stays for ambulatory procedures like surgery. Surgeries for uterine fibroids (hysterectomies and myomectomies) were identified between 2006 and 2014. Number of avoided surgeries through the use of UPA was estimated by comparing trends before and after the commercialization of the product in France (August 2013). Number of patients treated with UPA was recalculated from the number of units sold between 2013 and mid-2016, based on GERS data. For the subsequent years, data were extrapolated and trends were supposed to stabilize from the end of 2016. RESULTS:  In 2012, 34,480 surgeries for UF were performed, 46% of which were hysterectomies. Before the launch of UPA in France, number of surgeries increased by 380 each year. The introduction of UPA was correlated with a trend reversal, showing a decrease in the number of surgeries of 1,236 each year from mid-2013. UPA did not have an impact on the type of surgery, neither on the surgical approach. The savings associated with the use of UPA pre-operatively (cost of treatment and avoided surgeries included) were estimated at 2M€ in 2013 and will reach 9M€ in 2016, that was considered as a plateau for the following years. The cumulated budgetary impact from 2016 to 2019 is estimated at -37M€. CONCLUSIONS: Thanks to avoided surgeries, the use of UPA as pre-operative treatment is associated with financial savings, which cover largely the treatment costs.