OBJECTIVES: Hysteroscopy, a common gynaecological procedure, can be conducted in inpatient, daycare or outpatient setting. The costs of hysteroscopy conducted in the different settings vary between healthcare systems. This study aims to describe the cost of hysteroscopy in inpatient, daycare and outpatient settings in a tertiary-care hospital in Malaysia from the healthcare provider perspective. METHODS: Resource use data were collected from the medical records of patients who underwent hysteroscopy in 2014. Unit costs were estimated by combining top down (general overheads for hospital services) and bottom up (activity-based costing for clinic visits, hospitalisation, procedures and diagnostic investigations) approaches. The equipment costs of hysteroscopes were annualised based on the purchase price and number of users. RESULTS: Patients who met the inclusion criteria (n=111) underwent hysteroscopy in daycare (n=29) and inpatient (n=65) settings with a rigid hysteroscope under anaesthesia while the outpatient (n=17) setting used a flexible hysteroscope without anaesthesia. The average cost per patient in outpatient, daycare and inpatient settings were RM1547, RM1681 and RM1987 respectively (price year 2014). The main cost drivers were: equipment costs for outpatient setting (65% of total cost), operation theatre costs for daycare setting (33% of total cost) and ward costs for inpatient setting (40% of total cost). A hypothetical scenario analysis with equal number of patients undergoing hysteroscopy in each setting estimated the average cost per patient in outpatient (n=50), daycare (n=50) and inpatient settings (n=50) would be RM874, RM1492 and RM2036 respectively. CONCLUSIONS: Stratifying patients who are eligible for outpatient hysteroscopy and thus optimising its use could potentially be cost-saving to the Malaysian healthcare system while achieving similar diagnostic efficacy.