This study compares the expected 5-year costs for permanent sterilization in women between nonincisional hysteroscopic tubal occlusion with the Essure system performed in an office setting and laparoscopic bilateral tubal ligation (LBTL).An economic decision tree is used to predict outcomes and costs to compare these two procedures from a US Medicaid perspective over a 5-year time horizon.Expected costs are $2367 for Essure and $3545 for LBTL (Essure saves $1178 or 33% of LBTL costs). Sensitivity analyses show Essure has lower expected costs across all values considered. If the cost for a LBTL procedure were to decrease by 20% and the cost for Essure to increase by 20%, Essure would have still have lower expected costs.Office-based sterilization for women using Essure can lead to substantial cost savings over 5 years compared to LBTL. This conclusion is robust to varying analytic inputs.