OBJECTIVES: Bevacizumab, a humanized monoclonal IgG antibody against the vascular endothelial growth factor (VEGF), is reimbursed in the Czech Republic in combination with chemotherapy for the first-line treatment of patients with metastatic colorectal cancer (mCRC). However, its high cost is a potentially limiting factor. METHODS: The cost and effectiveness of bevacizumab in the real clinical practice was retrospectively evaluated in the National comprehensive cancer center from the perspective of healthcare payer. Cost data (examination, medication, hospitalization) were collected since the initiation of bevacizumab treatment to any tumor response (RECIST criteria - Complete Response (CR), Partial Response (PR), Stable Disease (SD), Progressive Disease (PD)) and/or to death. Minimal follow-up for all patients was 12 months. Costs were valued in CZK and converted to EUR (€1= CZK 25.78). RESULTS: A total of 218 patients with mCRC were treated with bevacizumab in the first line treatment (132 men (60.6%); mean age 58.3 years) between 11/2005-12/2010. The most frequent chemotherapeutic regimens were: XELOX (55%), FOLFOX (26%), and FOLFIRI (4%). The treatment was mostly discontinued due to PD (59% patients); further due to SD, PR or CR (total 8.3% patients), adverse events (7.8% patients), surgery (5.5% patients). During our follow-up period PD was recorded in 89% patients; 66% patients died. The mean cost per progression-free survival (median 9.1 months) was EUR 38,870.3 (CZK 1,002,076.3); the mean cost to response PR, CR or SD was EUR 42,894.6 (CZK 1,105,823.1) after median 9.8 months of treatment. The median overall survival was 16.9 months and the mean cost since initiation of treatment to death was EUR 50,791.3 (CZK 1,309,400.8). CONCLUSIONS: The reimbursement of medication was the main cost driver observed in our analysis. Drugs made up more than 93% to PR, CR or SD, 91% to PD and 88% to death of the total cost per patient respectively.