OBJECTIVES: To assess the resource utilization and direct medical costs associated with palliative care for cancer patients in Brazil under the private payer and the patient perspective. METHODS: The target population consisted of adult patients diagnosed with cancer under palliative care. A modified Delphi panel validated and supplemented international published data, and estimated standard treatment patterns in Brazil. The study included only direct medical costs for managing pain, dyspnea, depression and other complications during hospitalization, home care or ambulatory care. The time horizon was six months, due to the short survival of patients under palliative care. RESULTS: During palliative care, 2% of patients needed hospitalization in the Intensive Care Unit and 18% in a general ward; 28% were under home care and 52% under ambulatory care. Total weighted average direct medical costs for six months were R$13,108 (US$8,091) per patient, of which R$8,964 (US$5,533) were reimbursed by the private payer and R$4,144 (US$2,558) were out-of-pocket expenses for the patient. Considering total costs of care, the treatment of pain, dyspnea and depression represented 19%, 14% and 10% of total costs respectively. Hospitalization and home care were the major cost items, accounting for 43% of total costs. Under the private payer perspective, these same percentages were 4%, 16%, 0% and 63%, respectively. Under the patients’ perspective the percentages were 51%, 11%, 32% and 0%. These differences highlight the fact that medication is only reimbursed when used during hospitalization. CONCLUSIONS: Palliative care is becoming a relevant field of study in Brazil recently. This cost of illness study estimated an average cost of patients in six months under palliative care of R$13,108, considering both private payer’s and patients’ out-of-pocket costs. For the private payers the main cost item was hospitalization/home care and for patients it was the treatment of pain.