Objective: To determine the cost-effectiveness ratio for quarterly injections of Ranizumab in the treatment of Wet AMD, in Brazilian HMOs scenario. Methods: A cost-effectiveness analysis from the private payers perspective, with a time horizon of five years were conducted. A decision tree with a Markov chain considering the probabilities of increasing, decreasing or maintaining visual acuity (VA) through five health states based on VA from 20/40 to 20/400, were performed. Study comparators examined were Ranibizumab (RAN), and Pegaptanib Sodium (PEG). The clinical aspects regarding benefits (Vision Year Gained) and probabilities of transition data were extract from a meta-analysis of randomized clinical trials for the alternatives. Treatment costs including adverse events were collected from private payers reimbursement reference list for professional, procedures and diagnostics fees and the drugs costs were collected from manufactures price list. Costs and benefits were validated by a panel of Brazilian specialists through the Delphi technique. The discounting rate was 3% for costs and benefits, the results were converted in US Dollars (R$ 1.8/USD 1.00). A one-way sensitivity analysis was performed. Results: Patients using Ranibizumab get more benefits (RAN=2.66 per vision year gained; PEG=2.00 per vision year gained), with the lowest total cost per treatment (RAN=$29,653 USD; PEG=$30,093 USD) and the lowest cost per QALY (RAN=$11,148 USD/vision year gained; PEG=$15,046.5 USD/per vision year gained). Incremental analysis showed Ranibizumab to be the dominant alternative. Net benefits are greater with Ranibizumab independent of willingness to pay. The sensitivity analysis on efficiency and costs of Ranibizumab results show that the results are sensitive to the type of lesion treated. Conclusion: Ranibizumab is the dominant therapy; it offers better benefits in vision years gained at the lowest cost. The results are sensitive to the type of lesion treated, showing the need of guidelines to assure the best resource allocation.