OBJECTIVES: Budget silos can hinder reimbursement when a healthcare investment from one department incurs savings in another. For patients with hepatocellular carcinoma (HCC) at intermediate (BCLC-B stage) or advanced (BCLC-C) stages, transarterial radio-embolization (TARE) has the potential to improve survival, a favorable safety profile and successful outcomes in patients with portal vein thrombosis (PVT). Given its outpatient administration, low number of treatments and low toxicity relative to conventional transarterial chemoembolization (cTACE), TARE may be associated with overall decreased hospital resource use. A budget impact analysis (BIA) was undertaken from a Canadian hospital perspective. METHODS: The epidemiological BIA included costs of drug and device acquisition and key cost drivers of administration (inpatient, outpatient or self-administered) and management of adverse events (AEs). In intermediate HCC, TARE with yttrium-90 glass microspheres was compared to TACE, an inpatient procedure, including cTACE and drug-eluting beads TACE (DEB-TACE). In advanced HCC, with or without PVT, TARE was compared to self-administered sorafenib. The Ontario Case Costing Initiative database, published literature and expert opinion were utilized. AE management was based on published rates for TARE, cTACE, DEB-TACE and sorafenib. RESULTS: For a Canadian hospital managing 200 HCC patients annually, reimbursing TARE incurred savings of approximately $37,000, $55,000 and $75,000 in years 1, 2 and 3, respectively. In year 3, it includes incremental costs of $207,000 for device acquisition, savings of $281,000 for administration and savings of $1,000 in AE management. Sixty-six percent of HCC patients were deemed eligible, of which 8, 13 and 17 patients were anticipated to undergo TARE in years 1, 2 and 3, respectively. CONCLUSIONS: TARE is associated with cost savings and decreased hospital resource use, which enhance the ability of the hospital to manage scarce resources. Decisions made from one department’s perspective alone may therefore underestimate the true value for the hospital.