OBJECTIVES The objective of the study was to compare the efficacy and treatment costs of FLUCAM versus FCR in the second line treatment of CLL in a one year time horizon under the Brazilian private health care system (BPS) perspective. METHODS A literature review was performed and two phase II trials were found, evaluating the efficacy of FLUCAM (JCO 2005;23:7024) or FCR (JCO 2005;23:4070). FLUCAM presented higher response rates and lower overall survival and time to disease progression than FCR. Grouping patients from both studies into risk groups, and assuming median overall survivals of 11, 6 and 2 years for low, intermediate and high risk patients, respectively, resulted in an expected median overall survival of 2.89 years for FLUCAM and 4.15 years for FCR. This reflects the higher disease severity in the FLUCAM study population at baseline. Therefore, it cannot be concluded through an indirect comparison that one treatment is superior to the other. Assuming equivalent efficacies for both treatments, a cost-minimization analysis was developed. Study protocols were valued considering an average body surface of 1.7m2 and maximum prices to consumer for drugs. Antimicrobial prophylaxis and pre-treatment drugs were included. The average number of cycles administered was 4.2 cycles for both protocols. Dose reductions were considered for FCR. Eighty-six of patients have received normal dosage, 13% had a level 1 dose reduction starting on the third cycle, and 1% had a Level 1 reduction at Cycle 3 and a Level 2 reduction from Cycle 4. RESULTS Treatment costs found in one year were R$36,370 for FLUCAM and R$63,778 for FCR, representing a cost reduction of R$27,408 (US$11,874) in favor of FLUCAM. CONCLUSIONS Assuming equivalent efficacies for both treatments, FLUCAM presented a lower total treatment cost than FCR, being a valuable alternative in face of budget constraints, for the BPS.