OBJECTIVES: Erythropoiesis-stimulating proteins (ESPs) are used in the treatment of chemotherapy-induced anemia (CIA) with the aim of improving quality of life and reducing the need for blood transfusions.  A retrospective analysis based on data from a single institution compared costs and effectiveness of two ESPs, epoetin alfa  and darbepoetin alfa , in consecutively treated patients over a 2-year period. METHODS: Data from all patients treated for CIA between January 1, 2007 and December 31, 2008 with one of the two ESPs – epoetin alfa- (40 000 IU once weekly) or darbepoetin alfa- (500µg every 3 weeks) - were analyzed. Total and per patient costs and costs per clinical response (hemoglobin  ≥11 g/dL) were calculated, based on drug acquisition costs for the ESPs. RESULTS: A total of 161 patients were treated with epoetin alfa (799 doses; mean 4.96 doses per patient) and 52 with darbepoetin alfa  (94 doses; mean 1.81 doses per patient). Total and per-patient costs were 8,682,226 CZK (€331,003.66) and 54,461 CZK (€2076.29) for epoetin alfa versus 2,578,984 CZK (€98,321.92) and 49,596 CZK (€1,890.81) for darbepoetin alfa. The response rate was higher (58% vs. 47%, not statistically significant), and the mean cost per treatment response was lower, with darbepoetin alfa, at 85,966 CZK (€3,277.39) versus 115,763 CZK (€4,413.38) for epoetin alfa.  CONCLUSIONS: Our results indicate that darbepoetin alfa is associated with lower drug acquisition costs than epoetin alfa, as well as a lower cost per treatment response, for treatment of CIA.