OBJECTIVES: To evaluate the cost-effectiveness of PPH compared to MM for treating prolapsed internal haemorrhoids from the NHS's perspective. METHODS: A cohort-based model with a decision tree structure was developed to investigate the cost effectiveness of PPH in the treatment of haemorrhoids; the primary outcome was total direct NHS cost and QALYs. Patients in whom surgical intervention is considered appropriate enter the model having undergone either a PPH or MM procedure. The patient then goes through a recovery period during which a proportion of the patients may suffer a recurrent prolapse. The severity of the recurrent prolapse determines whether the patient is able to self-treat or requires further surgery. Those who require re-surgery are readmitted to hospital and undergo the same procedure they had on entry to the model. Resource utilisation associated with procedure cost and post operative complication was estimated by NHS reference costs 2006. RESULTS: Cost drivers were identified as the cost of the stapling device and reductions in length of stay in the PPH group. QALYs were driven by reductions in post-operative pain from PPH. Total direct NHS costs per were £ 972.66 and £ 928.66 for PPH and MM, respectively. PPH vs. MM offers a cost saving of £ 10.74/patient due to less length of stay and OR time considering the initial surgical procedure, and an incremental cost after one year of £ 43.70. QALYs were 0.7675 and 0.7591 (PPH vs. MM, respectively). The ICER for PPH vs MM was estimated at £5188.09 per QALY. Probabilistic sensitivity analysis demonstrated the results to be robust. CONCLUSION: PPH is a valuable alternative to MM in patients where surgical intervention is indicated. Efficacious without compromising QoL, whilst decreasing length of stay and OR time, PPH can be considered a cost-effective procedure for prolapsed internal haemorrhoids.