OBJECTIVES: The Pipeline Embolization Device (PED) is a flow diverter system designed to treat intracranial aneurysms. This study focuses on unruptured, wide neck, giant intracranial aneurysm, and aims at identifying the cost-effectiveness of PED compared with current standard therapies available in the Mexican public healthcare system. METHODS: To predict clinical endpoints and costs over a 15-year time horizon, a decision analytic model (Markov) was developed.  The model has a short-term component with three health states based on major radiologic outcomes: complete occlusion, residual neck, and residual aneurysm; and a long-term component with three health states: reintervention, rupture and death. The endovascular procedures of coiling and stent assisted coiling were identified as comparators. Clinical efficacy was measured using radiological outcomes; all clinical trials used the same assessment tools facilitating comparison. Costs were taken from public available sources considering direct medical costs only. Results were presented as incremental cost per life years gained in national currency. RESULTS: PED showed to have an ICER of $103,839.34 versus coiling, 117,043.87 when compared to stent-assisted coiling and $20,711.69 when compared with the no intervention strategy in a 15-year temporal horizon scenario. PED obtained an ICER below Mexican GDP threshold per life years gained, versus the rest of the competitors in the mentioned timeline. Other ICERs for different time horizons will be shown in the sensitivity analysis. CONCLUSIONS: PED represents a cost-effective strategy for the treatment of this particular type of  aneurysmal lesions when compared with the current available endovascular treatment options in the Mexican public healthcare system.