OBJECTIVES: To compare the efficacy and costs of treatment strategies using terlipressin or noradrenaline for cirrhotic patients with hepatorenal syndrome, under the perspectives of the Brazilian public health system and a major private health insurance.  METHODS: Comparison of efficacy was performed through a systematic review with meta-analysis of randomized controlled trials, using random-effects model. Economic evaluation was performed through cost-minimization. Costs were expressed as International Dollars (Int$).  RESULTS: Four studies (154 patients) were included in the meta-analysis. There was no evidence of difference between treatments with terlipressin or noradrenaline regarding 30-day survival (risk ratio of 1.04, 95% confidence interval of 0.84-1.30, p=0.70). Under the perspective of the public health system, costs of treatments with terlipressin or noradrenaline were Int$ 7,437.04 and Int$ 8,406.41 respectively. Regarding the perspective of the private health insurance, costs of treatments with terlipressin and noradrenaline were Int$13,484.57 and Int$15,061.01 respectively.  CONCLUSIONS: There was no evidence of superiority between treatment strategies using terlipressin or noradrenaline regarding survival of patients with hepatorenal syndrome, but the strategy using terlipressin was more economical under different perspectives.