OBJECTIVES: To compare the total costs of XELOX (oral capecitabine + IV oxaliplatin) ± bevacizumab versus FOLFOX-4 (IV 5-FU/ folinic acid/ oxaliplatin) ± bevacizumab in the first line treatment for patients with metastatic colorectal cancer (mCRC) in Saudi Arabia from a health-care provider and societal perspectives. METHODS: The analysis was based on a non-inferiority phase III clinical trial data done by Cassidy et al. in 2008. Direct medical and indirect costs were contrasted. Drug acquisition costs were estimated using published sources. Drug administration costs for each regimen and hospitalisation costs were calculated using values derived from a Saudi Arabian-specific survey and observation. Data taken directly from the trial and used in the analysis include treatment duration, adverse event frequency and central venous access management. Indirect costs derived from the time that the patient incurred in the chemotherapy administration process and the time consumed by travelling to the health care centre. RESULTS: Total direct medical cost estimates were considerably lower for 3-weekly XELOX compared with bi-weekly FOLFOX that resulted in savings equivalent to SR 42,660 (US$ 11,346) per patient which were mainly due to lower drug administration costs. Correspondingly, total direct medical cost estimates were substantially lower for XELOX + bevacizumab compared with FOLFOX + bevacizumab by SR 55,236 (US$ 14,690) per patient. The drug acquisition costs was higher for XELOX. However, this was offset by XELOX’s reductions in other health-care resources consumption such as the use of central venous access and other medications. Regarding indirect cost estimates, patient time and travel costs were lower for XELOX by SR 5815 (US$ 1547) per patient due to fewer visits and cycles. CONCLUSIONS: XELOX ± bevacizumab is cost-saving in comparison to FOLFOX-4 ± bevacizumab from both health-care provider and societal perspective in Saudi Arabia.