OBJECTIVES: The objective was to compare the first-line therapy costs of capecitabine+cisplatin(XP) and 5-FU+cisplatin (FP) in patients with AGC in the Romanian health care system. METHODS: Due to similar efficacy as shown in the study ML 17 032 (Kang et al.) a cost minimization analysis was performed (CMA). Direct costs of the two alternative therapies were estimated based on the trial results on actual dose and the number of administrations, and unit costs in Romanian hospitals from payer perspective (National Health Insurance House). Adverse event (AE) profiles were used to calculate costs of treating AEs.  An expert panel estimated typical treatment patterns and costs of treating major AEs. RESULTS: XP arm patients received 5.2 cycles vs. 4.6 cycles in FP arm. The substitution of oral capecitabine for infusional 5-FU reduced the number of hospital clinic visits by 17.6 (22.8 for FP versus 5.2 for XP). Drug costs were estimated to be ROL 5,230 greater in the XP arm, but drug administration costs were ROL 5,904 lower, yielding a net cost saving of ROL 674 per patient (1Euro=4,2 ROL). Adverse event profiles were almost similar: associated costs to treat AEs were less than ROL 270 per patient and were lower in the XP arm by ROL 67. Total incremental cost was - ROL 741 in favor of XP regimen. CONCLUSIONS: Oral capecitabine treatment is a cost-saving regimen for AGC from Romanian public payer’s perspective.