OBJECTIVES: Octreotide LAR has shown antiproliferative activity in advanced midgut neuroendocrine tumors (NET) increasing time to tumor progression (TTP) compared to placebo. This study aims to assess the costs and consequences of OCT-LA versus best supportive care (BSC) in patients with metastatic midgut NET from the private payer perspective. METHODS: A 3 health state (Progression Free Survival, Progression and Death) Markov model with a 10 year time horizon was developed with data from the phase III PROMID trial. Within the trial, subjects remained on treat­ment until progression. Resource use was estimated through published data and input from clinical experts to reflect clinical practice in the Brazilian private setting.  Unit costs were obtained from Brazilian official sources. Costs and outcomes were discounted 5% per annum. RESULTS: The model estimated 14 months PFS with OCT-LA versus 6 months with BSC. Estimated PFS gain was 0.60 years (1.07 versus 0.46). Total cost of treatment was 275,497 BRL for BSC and 303,111 BRL for OCT-LA. The incremental cost per progression free year gained was 28,706 BRL in the OCT-LA arm vs. BSC due to treatment until progression. The mean cost of supportive care for progressive disease represented 87.3% (239,883 BRL) and 76.9% (224,388 BRL) of the final cost of treatment for BSC and OCT-LA, respectively. Results remained consistent when univariate sensitivity analyses were run. CONCLUSIONS: OCT-LA is a clinically effective option to control tumor growth in patients with metastatic midgut NET.  OCT-LA provides longer TTP compared to BSC for those patients. Although there is ecological evidence to suggest improvement in OS after introduction of OCT LA, the ICER for an additional life year gained is not currently calculable as the PROMID trial was not designed to evaluate OS. Further areas of research to elucidate the association between PFS and OS in NET are needed.