OBJECTIVES: A recently published retrospective analysis of the US Premier Hospital Database comparing two different active flowable hemostatic matrices (Floseal and Surgiflo) indicated that surgery time, risk of blood transfusion, and amount of matrix used are greater with Surgiflo compared to Floseal in major and/or severe spine surgeries.[1]This analysis was undertaken to evaluate the cost-consequences to hospitals of using Floseal vs. Surgiflo in major and severe spine surgery patients. METHODS: A cost–consequence model framework was constructed from a US hospital provider perspective. Model parameters combined clinical inputs from the retrospective database analysis with the average annual number of major and severe spine surgeries and blood transfusion costs analyzed using the 2012 Healthcare Cost and Utilization Project’s (HCUP’s) National Inpatient Sample (NIS) database (represents 95% of all U.S. community hospital discharges). Additional parameters like cost of hemostatic matrices and operating room were identified from RED BOOK™ and published literature. Various one-way and probabilistic sensitivity analyses were performed. RESULTS: Compared to Surgiflo (base case - 167 major and 60 severe spine surgeries annually), Floseal required 8 fewer blood transfusions and reduced 52 hrs. of OR time, resulting in annual savings of $250 per major and $362 per severe spine surgery patient in addition to totally offsetting the product cost. Monte-Carlo simulations showed that annual savings in major and severe spine surgery patients were greater than $41,724 and $21,732 respectively, in 47% to 55% of the iterations. CONCLUSIONS: This analysis indicates that using Floseal instead of Surgiflo as an adjunct to hemostasis in both major and severe spine surgery could potentially lead to sizable cost savings for hospitals.