OBJECTIVE: Lung cancer is a major cause of death in the UK and small cell lung cancer (SCLC) represents about 20% of primary lung tumors. The costs associated with the management of SCLC are significant, however few studies have been conducted in the UK to determine their true extent. The aim of this study was to obtain an estimate of the current patterns of treatment and associated resource use and costs for SCLC in the UK. METHODS: Study sites were two hospitals in Newcastle-upon-Tyne. A focus group meeting with local clinicians clarified the expected pathways of SCLC care. Forms for retrospective patient record data extraction were developed on a per treatment phase basis. Data was collected on a consecutive series of 106 patients diagnosed with SCLC between 1994 and 1997. Unit costs were determined from local hospital accounts and secondary sources. RESULTS: Per treatment phase average costs and associated percentages for the first 56 patients were: referral and diagnosis £1,964 (11.21%); active therapy £6,147 (35.09%); follow-up £1,103 (6.30%); retreatment(s) £3,804 (21.72%); subsequent follow-up(s) £560 (3.20%) and terminal care £3,937 (22.47%). The high cost of active therapy was primarily due to the long inpatient stays associated with chemotherapy. Similarly, the high cost of terminal care was predominantly due to hospitalizations and/or hospice stays. The total average cost of treatment pre-recurrence exceeded that of post-recurrence (52.6% of costs vs. 47.4%). CONCLUSION: The results of this analysis show that the average costs of treating SCLC are considerable, although the variability between patients in terms of the type and quantity of resource use was very high. Such analyses provide a useful insight into resources used in actual clinical practice. This study has identified the major cost drivers and when combined with outcome data will form the basis of future economic evaluations of SCLC treatments.