Background: The aim of this study was to compare the outcome and cost-effectiveness of laparoscopic (LA) and open appendectomy (OA). Methods: Forty consecutive patients were randomized to either the LA (n= 19) or OA (n= 21) group. Results: The medians of operative times in the LA and OA groups were 31.5 and 41 min, respectively. The total operation room times were 91 and 82 min, respectively. There was no significant difference in postoperative pain or fatigue, but return to normal life was faster in the LA group (14 versus 26.5 days). The median hospital costs per patient were 8,538 and 6,788 FIM ($1 US = 4.6 FIM) in the LA and OA groups, respectively; but the total costs among working patients were lower in the LA group (20,963 versus 27,778 FIM) due to faster return to work. Conclusions: Laparoscopic appendectomy is as safe as open appendectomy. The hospital costs are higher, but LA offers significant cost savings to the payer for working patients.