OBJECTIVES: To estimate the cost-effectiveness of strategies for treatment deep vein thrombosis (DVT),  the primary objective was to compare of effects of  catheter-directed thrombolysis (CDT) and anticoagulation versus anticoagulation in the management of people with DVT of the lower limb. DVT occurs when a blood clot forms in a leg vein. The clot can break up and move to the lungs, leading to a potentially serious blockage in blood flow (pulmonary embolism). Because of the damage to the leg vein, post-thrombotic syndrome (PTS) may develop any time over the next couple of years. METHODS: We used a Markov state transition decision model to evaluate the cost-effectiveness of treatment strategies using a societal perspective for costs, effectiveness-measured in incremental cost-effectiveness. Data sources included the English language literature using MEDLINE searches and bibliographies from selected articles.  RESULTS: Our study showed that CDT may have advantages over standard anticoagulation treatment. CDT effectively dissolved the clot so that complete clot breakdown occurred more often with CDT than with standard anticoagulant therapy. CDT and anticoagulation with compression stockings was associated with an effectiveness of 21.67 QALYs and a lifetime cost of $48 442. The incremental cost-effectiveness ratio (ICER) was $14 728/QALY gained. CDT increases the patency of veins and reduces the incidence of PTS following DVT by 35%. Strict eligibility criteria are necessary to reduce the risk of bleeding complications and this limits the applicability of this treatment. CONCLUSIONS: CDT and anticoagulation are highly cost-effective strategies for treatment patients with DVT and a low risk of bleeding. Use of strict eligibility criteria has improved the safety and acceptability of this treatment, with treatment directed by catheter in more extensive clots now the favoured method.