BACKGROUND: The literature on preoperative smoking cessation indicates that smoking patients are more likely to have postoperative complications. However, the economic implications of such complications are unclear. In particular, the balance between the cost of a preoperative intervention for smoking cessation (PISC) and the benefit resulting from the potential decrease in hospitalization costs is not known. METHODS: Only one previous study, a randomized trial involving smokers scheduled for hip or knee replacement surgery, provides sufficient data to simulate the hospital course of patients subjected or not subjected to a PISC. We used a multistate Markov-type model and official French hospital costs for 2008 to simulate this situation. The cost-benefit analysis adopted the payer's perspective. RESULTS: The mean benefit, corresponding to the decrease in the cost of the hospital stay for a reference case patient having followed a PISC, was estimated at 313 euros, with a corresponding mean cost of the PISC estimated at 196 euros. Therefore, the PISC was associated with a cost saving of 117 euros per patient. The results were most sensitive to the cost of ICU care as a proxy for cost of smoking-related complications, and to the relative risk of complication between patients with and without a PISC. CONCLUSION: Under the conditions simulated by this cost-benefit model, potential modest cost savings may accrue with implementation of an institution-based smoking cessation program through reduced total hospitalization costs that exceed the cost of the intervention.