OBJECTIVES: The purpose of this study was to explore the cost-effectiveness of abiraterone acetate (abiraterone) vs. cabazitaxel in metastatic castration-resistant prostate cancer (mCRPC) patients who progressed after docetaxel from the Greek healthcare perspective. METHODS: As no head-to-head trial data were available for abiraterone versus cabazitaxel, an indirect cost-effectiveness model was developed using clinical data (progression free survival (PFS), overall survival (OS), adverse events (AEs)) from the pivotal Phase 3 clinical trials COU-AA-301 (abiraterone) and TROPIC (cabazitaxel). The basic assumption in the model was that both comparator arms in the trials were ‘palliative’ and therefore equivalent. Resource use, particularly for the management of AEs, was estimated based on data from Alexandra University Hospital in Athens. For validation purposes, a secondary analysis was conducted using UK resource use data. Both analyses used local 2012 costs, undiscounted. Costs of hospitalisation, day hospital visits, drug administration and laboratory tests were taken from officially published public tariffs. Drug acquisition costs came from the latest Price Bulletins. Since abiraterone and cabazitaxel are not yet marketed in Greece, respective prices were estimated based on available EU prices in April 2012. Calculations were based on the median treatment duration for each agent. RESULTS: Total treatment cost was lower for abiraterone (€25.847) compared to cabazitaxel (€26.648). Higher drug acquisition costs for abiraterone (€24.899 vs. €23.886 for cabazitaxel) were offset by lower administration costs (€844 vs.  €2.292) and lower AE management costs (€104 vs. €470). The total treatment costs of abiraterone were €12.924 and €5.619 per incremental month of PFS and OS compared to palliative care, respectively; treatment costs for cabazitaxel were €19.034 and €11.103 per additional month of PFS and OS against palliative care, respectively. Results were validated by the secondary analysis. CONCLUSIONS: Abiraterone appears to be a potentially cost-effective option compared with cabazitaxel in the Greek healthcare setting.