A large number of laboratory tests, radiologic studies, and endoscopic techniques are available for the evaluation of the jaundiced patient. Similarly, the therapeutic options have increased with the development and improvement of endoscopic percutaneous and lapararoscopic procedures and the decreasing morbidity and mortality of open surgery. It can only be expected that new studies and techniques will be added to those currently in use. With limited resources, the challenge is and will be to select, on an individual basis, the most efficient and cost-effective evaluation and the management with the lowest morbidity and mortality and the best short- and long-term results. Studies should be requested only when they are believed to have a reasonable possibility of affecting decisions and outcomes. The goals of therapy (i.e., cure, palliation, quality of life) should be clear in each case and survival expectancy from the primary disease and associated conditions estimated. To achieve these goals, it is essential to have in-depth knowledge of the different possible underlying diseases, know the questions that need to be answered, and understand the benefits, limitations, costs, and complications of the different diagnostic and therapeutic maneuvers. The local expertise and the local socioeconomic reality where one practices are important variables to consider. Many studies are currently being conducted to evaluate cost effectiveness. In this article we outline some of the issues involved in the cost-effective management of these patients.