OBJECTIVES: To assess the cost and the resource use related to anaemia management with Aranesp®, Eprex® and Neorecormon® in patients with chronic renal failure treated with haemodialysis in Belgium; and to assess the effect of anaemia management on haemoglobin (Hb) levels. METHODS: Data on anaemia management and resource utilization were collected using a retrospective chart review conducted in 11 haemodialysis centres distributed across Belgium. From each centre between 30 and 40 patients were randomly selected. Data on drug use, transfusion, consultations, hospitalizations, diagnostic tests and Hb level were collected over a 1-year study period (1 December 2005 until 30 November 2006). The costs were calculated by multiplying each item of resource use with its unit cost (in 2007; in €) from the Belgian health care payer’s perspective (RIZIV/INAMI). RESULTS: A total of 335 patients were included of which 105, 132 and 98 were treated with Aranesp®, Eprex® and Neorecormon®, respectively. There were no demographic differences between the treatment arms. There were no statistically significant differences between the 3 ESAs in the total annual anaemia management cost in haemodialysis treated chronic renal failure patients despite differences in drug list prices between the 3 ESAs. The cost ranged from €8203 to €9281. There were no significant differences in the average weekly dose of ESA between the 3 drugs. Independent of the iron status of the patient, or when stratified by CRP level, the percentage of patients reaching a Hb level ≥11g/dl was similar in the 3 treatment arms and ranged from 76% to 81%. CONCLUSIONS: In patients with chronic renal failure, treated with haemodialysis, there were no significant differences between the 3 available ESAs in medical resource use, average dose of ESA needed, annual anaemia management costs from the perspective of the Belgian public health care payer and in Hb control.