OBJECTIVES The main objective of this analysis was to determine direct medical costs for pulmonary embolism (PE) in patient undergoing elective total hip replacement (THR) in Slovakia from the payer perspective in 2007. METHODS A retrospective cost of illness analysis of PE in patients undergoing elective THR during 2007 was realized from the health insurance company perspective. Data for used resources and respective costs were collected from the database of the biggest health insurance company in Slovakia. Costs in Euro were calculated with official exchange rate 30,126 Sk/€ Comparison of costs between group of patients with PE and group without PE was done. RESULTS The group of 2153 patients (845 men and 1 308 women) with elective THR was analyzed. The average age was 64.5 years (63.3 in men and 65.2 in women). Within this group there were 11 cases of PE (average age 66.4). Average direct medical costs for group of patients WITH and WITHOUT pulmonary embolism were €2513 and €1579 respectively, with the following structure of costs: inpatient – €2167 and €1265; drugs - €79 and 1€16; examinations and treatments during inpatient stay (SVALZ) - €198 and €131; outpatient - €69 and €67 respectively. CONCLUSIONS Average direct medical costs for patients with PE after elective THR are €2513. This is almost 60% more then the average direct medical costs for patients without PE. Main driver of increased costs is inpatient stay at intensive care unit and at internal medicine department after episode of pulmonary embolism.