OBJECTIVES: The objective of the study was to examine the direct medical cost of XELOX (capecitabine plus oxaliplatin) compared to FOLFOX (fluorouracil/leucovorin plus oxaliplatin) for the treatment of advanced colon-rectum cancer in China. METHODS: Since the equal efficacy was already demonstrated by the published literature and local clinical guideline, cost minimization analysis was performed to compare the direct medical costs of XELOX and FOLFOX for the treatment of advanced colon-rectum cancer. The direct medical costs were associated with the drug costs, drug administration costs, hospitalization costs and adverse events management costs. The costs were calculated based on a questionnaire survey from an expert panel of 23 pharmacists and 10 gastrointestinal surgeons and medical oncologists. RESULTS: According to the recommendation of expert panel, the standard treatment duration of XELOX and FOLFOX was 8 cycles and 12 cycles, respectively. The drug cost of XELOX regimen was CNY 47,306 (US$6926), higher than FOLFOX by CNY 22,118 (US$3238). However, the cost increment of XELOX regimen was offset by the higher drug administration cost (deviation CNY 6,820), hospitalization cost (deviation CNY 10,200) and adverse events management cost (deviation CNY 7,710) of FOLFOX regimen. As a result, XELOX showed a significant overall cost savings of CNY 2612 (US$382) compared with FOLFOX. CONCLUSIONS: According to the study, XELOX is cost saving in comparison with FOLFOX for the treatment of advanced colon-rectum cancer in China, especially in the chemotherapy administration and hospitalization utilization.