OBJECTIVES: The aim of this study was to estimate the cost-effectiveness of endoscopic sclerotherapy (ES) vs. ligation (EL) in prevention of rebleeding in children with oesophageal varices (OEV) from a Polish hospital perspective. METHODS: Retrospective analysis in 235 consecutive children with OEV treated with ES (206) or EL (29) was performed to quantify effectiveness and costs of alternative treatments. End-points of analysis were: variceal obliteration, referral to surgery or death. Varices were defined as "obliterated" when were too small to be treated by endoscopic methods. The effectiveness measure was percentage of obliteration of OEV after ES and EL respectively. Only direct medical costs resulting from the ES and EL, treatment of rebleeding before obliteration, complications and crossover from ES to EL, or from endoscopy to surgery for treatment failures were assessed. The costs were determined from actual resource consumption on a patients-specific basis and estimated using local data on unit costs. Uni- and multivariate and extreme scenario sensitivity analyses were performed. RESULTS: Obliteration of varices was achieved in 65% of children treated with ES and 90% treated with EL (p<0.01). The number of endoscopic procedures, bleedings, oesophageal dilatations and surgery per patient for ES and EL was 8.2 vs. 2.2; 1.3 vs. 0.2; 0.1 vs. 0.0; 0.2 vs. 0.07, respectively (p<0.05). The mean cost per patient was 16,577 PLN in ES and 3 742 PLN in EL group (1 PLN=4 USD). The threshold analysis suggests, that EL would lose the dominance, when the mean number of bleedings/patient decreased two-fold in ES group and increased ten-fold in EL group. CONCLUSION: Since EL in comparison to ES resulted in a better effect at a lower cost, this method was considered to be dominant for children with OEV.