BACKGROUND: A common urological cancer in South Korea, bladder cancer was one of the first cancers shown to be associated with carcinogens; cigarette smoking is, by far, the most common cause of the disease. South Korea has one of the highest prevalence rates for smoking in the world; in 2004, the prevalence of smoking among Korean men was estimated at around 50%. Evidence indicates that premature death as a result of smoking is increasing, suggesting that impact of smoking-related bladder cancer has yet to peak. Given the potential for increased patient numbers, estimates of health care resource utilization will be key to effective health care planning. OBJECTIVES: To estimate the current number of cystectomies, transurethral resection of bladder tumours (TURB) and cystoscopies utilised in the diagnosis and treatment of patients with suspected superficial bladder cancer. METHODS: A decision tree model was developed to estimate resource utilization among an incident cohort of newly presenting patients with suspected superficial bladder cancer.  Patients diagnosed with superficial cancer were assigned to one of three treatment algorithms on the basis of histological risk classification at initial TURB.  In the absence of published guidelines for South East Asia, algorithms were based on European Association of Urology Guidelines from 2006. The movement of patients through each diagnosis and treatment algorithm was based on the probability of recurrence and success of subsequent treatments based on the rates observed with white light-guided TURB for each risk group. RESULTS: It is estimated that 9,340 patients with suspected superficial bladder cancer will undergo 341 cystectomies, 11,806 TURBs and 18,222 cystoscopies each year in South Korea. CONCLUSIONS: A rising incidence of bladder cancer will have a substantial impact on health care resource utilization in South Korea. Improved diagnostic techniques are likely to benefit patients, health care systems and society in general.