Introduction: Hypoparathyroidism (HPT) remains the most common complication post thyroidectomy (TTx). Consequences include renal disease, abnormal bone metabolism, impaired quality of life and increased mortality. Hence, intra-operative identification and preservation of well-vascularised parathyroid glands is of immense importance. Several adjuncts have been developed for this purpose, including near infra-red autofluorescence (NIR-AF) imaging. This cost-benefit study aims to analyse the economic feasibility of the use of intra-operative NIR-AF for TTx, for the prevention of HPT. Materials & Methods: A probe based NIR-AF system was selected, with outlay cost $20,000, and $500 per operation. The annual cost of managing HPT equates to $1137.75/patient. Arbitrary permanent HPT rates of 1% and 15% were chosen for the purpose of calculations, based on 100 TTx/year. Results: Excluding outlay, the use of NIR-AF equates to $50,000/year. Assuming an average post-operative life expectancy of 15yrs, cost of managing HPT equates to $17,055/patient. NIR-AF would need to prevent 2.93 instances of permanent HPT/year to be cost effective. Assuming a surgical unit has a permanent HPT rate of 15%, NIR-AF would need to achieve a 20% reduction in the number of patients who develop permanent HPT to achieve cost effectiveness. For a 1% permanent HPT rate, NIR-AF would need to provide a reduction of 293%. Conclusion: This is the first economic feasibility study analysing the cost-effectiveness of the use of NIR-AF for the prevention of HPT post TTx. For a specific institution, the economic feasibility will be determined by the number of TTx performed and the HPT rates experienced. This may not be justifiable in units where HPT rates are low.