Objective: In patients with MBC, a common practice in Europe is to offer first line docetaxel or paclitaxel. However, one important drawback in their use is the potential for dose-limiting toxicity. An albumin-bound formulation (nab) of paclitaxel (Abraxane) was recently developed to overcome these safety drawbacks and to provide additional efficacy. To provide health economic data, a cost utility analysis comparing nab-paclitaxel to docetaxel, both as alternatives to paclitaxel was conducted for the United Kingdom (UK), France, Germany, Italy and Spain. Methods: The clinical data were obtained from a meta analysis of randomized trials. Health care resource use for the delivery of chemotherapy and the management of grade III/IV toxicity was collected from a survey of European medical oncologists and from the literature. Using the Time Trade-off technique, utilities were obtained from 70 female oncology nurses in the UK and France. Results: Nab-paclitaxel had the most favourable safety profile with the lowest incidence of grade III/IV neutropenia, febrile neutropenia, anemia, emesis and stomatitis. This translated to lower overall costs for managing the grade III/IV toxicity relative to both docetaxel and paclitaxel (e.g. in France; €286 vs. €966 vs. €422). Using the median number of cycles administered and the cost of toxicity in each country, the overall cost for nab-paclitaxel was higher than conventional paclitaxel, but comparable to docetaxel. Overall, 47 of 70 (67.1%) respondents selected nab-paclitaxel as their preferred choice. As an alternative to paclitaxel, the incremental cost per QALY gained was lower for nab-paclitaxel than docetaxel in three of the five countries evaluated. Conclusion: Given its more favorable safety profile, improved efficacy and comparable overall cost, nab-paclitaxel can be considered a preferred option over docetaxel in MBC. As an alternative to paclitaxel, each of the European health care bodies must decide if the cost per QALY gained for that country represents good value.