Objective To analyze the hospitalization cost of echinococcosis surgery patients and its influencing factors in Gansu provincial designated echinococcosis hospital, and to provide basis for effieicent management of the medical cost for echinococcosis. Methods Data of echinococcosis patients who underwent surgery at provincial designated hospital in Gansu Province from January 2014 to December 2023 were collected. The data included patients’ basic information (hospitalization year, gender, occupation, age, medical insurance type, ethnicity), clinical information (admission pathway, whether transferred from another department, length of hospital stay, type of echinococcosis, disease outcome, presence of complications, location of cyst, type of surgery), and hospitalization cost data (total hospitalization cost, surgery cost, western medicine cost, consumables cost, diagnostic cost, other costs). Data analysis was conducted using the SPSS 29.0 statistical software. Median was used to represent the hospitalization cost. In single factor analysis, Mann-Whitney U test was used for comparison between two groups, and Kruskal-Wallis H test for comparison among multiple groups for non normal distribution data. Multivariate analysis was performed using multiple linear regression. Results A total of 540 echinococcosis surgery patients’ data were collected, including 504 patients with cystic echinococcosis and 36 patients with alveolar echinococcosis; 280 females and 260 males, with a total combined hospitalization cost of 20 809 800 yuan, a per capita hospitalization cost of 38 528.41 yuan, and median hospitalization cost of 33 732.87 yuan. In 2014 versus 2023, the hospitalization costs for patients with echinococcosis per capita increased from 31 276.59 yuan to 45 902.34 yuan. The median hospitalization costs for male and female cases were 35 232.35 and 31 891.16 yuan, respectively, and the difference was statistically significant (Z = -2.343, P < 0.05); the median hospitalization cost for patients ≥ 61 years old was the highest, 35 233.75 yuan, and the cost difference between different ages was statistically significant (P < 0.05); the median hospitalization cost for individual patients was the highest, 39 843.04 yuan, and the difference in hospitalization costs between different occupations was statistically significant (P < 0.05); the median hospitalization cost for Dongxiang patients was the highest at 65 401.29 yuan, and the difference in hospitalization costs between different ethnic groups was statistically significant (P < 0.05); the median hospitalization cost for patients transferred to ICU was 62 720.04 yuan, higher than the 32 526.89 yuan for patients who were not transferred to the department, and the difference was statistically significant (Z = -7.440, P < 0.05); the median hospitalization cost of patients with hospitalization time ≥ 21 d was the highest at 54 433.71 yuan, and the difference in hospitalization cost between different hospitalization times was statistically significant (P < 0.05); the median hospitalization cost of patients with multilocular echinococcosis was 43 949.85 yuan, higher than that of patients with fine-grained echinococcosis at 33 555.82 yuan (Z = -3.317, P < 0.05); the median hospitalization cost of transferred patients was the highest at 104 536.50 yuan, and the difference in hospitalization costs for different types of disease transfer was statistically significant (P < 0.05); the median hospitalization cost among patients with complications was 46 855.89 yuan, higher than that of 32 476.43 yuan for patients without complications (Z = -6.060, P < 0.05); the median hospitalization cost of patients with hepatic echinococcosis was 32 433.02 yuan, which was lower than that of patients with multi-organ echinococcosis, which was 43 550.83 yuan (Z = -4.933, P < 0.05); the median hospitalization cost of patients who underwent liver transplantation was the highest, which was 170 030.84 yuan, and the difference in hospitalization costs between different surgical procedures was statistically significant (P < 0.05). The results of multivariate linear regression analysis showed that the main factors influencing the cost of hospitalization for patients undergoing surgery for echinococcosis were year of hospitalization (t = 5.937, P < 0.01), age (t = 3.349, P < 0.01), occupation (t = 2.238, P < 0.05), whether or not to transfer to a different department (t = 8.778, P < 0.01), length of hospitalization (t = 7.346, P < 0.01), type of echinococcosis (t = 6.049, P < 0.01), the presence or absence of complications (t = 5.967, P < 0.01), location of cyst (t = 3.767, P < 0.01). Conclusion The per capita hospitalization cost of echinococcosis surgery patients in provincial designated hospital increased year by year from 2014 to 2023, The main factors influencing of hospitalization costs include year, age, occupation, whether or not to transfer to a different department, length of hospitalization, type of echinococcosis, the presence or absence of complications and location of cyst.