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Background Timely palliative care (PC) improves quality of life, symptom control and time spent at home in patients living with advanced cancer. Cost effectiveness of a pragmatic PC trial in outpatient cancer clinics for advanced colorectal cancer (CRC) was evaluated.Methods This is a before-and-after pragmatic study of CRC decedents in Alberta, Canada from January 1, 2016 to December 31, 2020. The intervention group received systematic screening for unmet PC needs, templated ‘shared care’ letters and access to early PC specialists. The control group received usual care. Primary outcomes were healthcare costs and days spent at home (last 90 days of life). A difference-in-differences (DID) approach used generalized linear models (GLM) for costs and ordinary least squares (OLS) for health outcomes.Results In 695 decedents, the intervention group saw an average cost reduction of $4,467 per decedent, decreasing from $33,880 to $31,607, while costs rose in the control group. It was cost dominant with an overall DID increase of 2.3 community days.Conclusion Specialist-led PC for CRC patients may offer meaningful cost savings and improved end-of-life outcomes.