OBJECTIVES: Bleeding in liver surgery can be difficult to control due to extreme vascularity and tissue fragility, including compromised liver (e.g., cancer). Blood loss may be minimized with hemostats that have rapid effect and may impact cost of care. This study estimated budget impact of using EVARREST vs. SoC in hepatic surgery based on two randomized trials. METHODS:  An economic analysis was developed to quantify 30-day cost impact of EVARREST from a U.S. hospital perspective. Key resources, from two randomized trials (n=180), included initial treatment, retreatment, operating time, transfusions, ventilator, and hospitalization. Transplant patients (n=6) where normal liver tissue was resected were excluded from analyses.  SOC was composed mainly of manual compression alone or with hemostats. The surgical analysis included resources clinically related to significant hemostasis benefits of EVARREST (i.e. retreatment, operating time, transfusion). A hospital analysis included all resources collected. Economic analyses were completed for the following subgroups: abnormal liver, metastatic cancer, anatomic/non-anatomic liver (classifications using IHPBA definitions), cirrhotic/steatotic liver, and if patients were obese or coagulopathic. Published U.S. costs were applied to resource use. Analysis results were weighted based on trial size.  RESULTS:  The surgical analysis predicted that the EVARREST cost was offset vs. SoC with a trial-weighted cost impact of $719 per patient.  The hospital analysis predicted further resource reduction with EVARREST with trial-weighted cost-savings of $868 per patient.  Subgroup analyses demonstrated a range of results from cost impact to cost savings with EVARREST vs. SOC (i.e., $1,976 to -$5,430 per patient, hospital analysis).  EVARREST use in coagulopathic patients was found to have the largest degree of cost savings with $1,859 and $5,176 per patient anticipated, surgical and hospital results respectively. CONCLUSIONS: In addition to meeting an important unmet need in controlling problematic bleeding in liver tissue, this analysis suggests that EVARREST can be a cost saving strategy.