Thoracic epidural anaesthesia (TEA) combined with general anaesthesia (GA) is widely used in clinics, but its cost-effectiveness has rarely been studied. We hypothesised that TEA combined with GA is beneficial for patients undergoing esophagectomy without increasing their costs. Eighty patients scheduled for thoracic esophagectomy were randomised to receive TEA combined with GA (TEA group) or general anaesthesia alone (control group). The following indicators were recorded: hospital stay, patient satisfaction, time to extubation, intraoperative anaesthetic dosages and fluid transfusion, postanaesthesia care unit stay, visual analogue scale score and anaesthesia-related complications. Statistical analysis utilised the Kruskal-Wallis rank sum test and the χ2 test. The TEA group exhibited significantly improved indicators on time to extubation, postanaesthesia care unit stay, visual analogue score, anaesthesia-related complications, hospital stay (P<0.05 for all measurements), and patient satisfaction (P<0.01) compared with the control group. However, the direct medical expenses did not differ significantly between the two groups. TEA combined with GA resulted in better prognosis and higher satisfaction without increasing the medical expenses. This combination is also a cost-effective anaesthesia regimen for esophagectomy.