OBJECTIVES: There is available evidence from a systematic review with meta-analysis that MFR and SFR have comparative efficacy in the treatment of bone metastasis. We aimed to compare the costs of MFR (20 Gy in five applications or 30 Gy in ten applications) versus SFR in the treatment of bone metastasis and pain control and determine the budgetary impact for PHC providers in Brazil. METHODS: all patients submitted to antalgic palliative radiotherapy for bone metastasis, from January 2009 to December 2009, were retrieved from Evidencias Cancer Treatment Database (www.evidencias.com.br). We evaluated a 50.000 lives’ HPC and projected the results for a 1,000,000 population. We used data from the above mentioned SR with MA to support the calculations of the projected costs for both types of treatment. RESULTS: The annual incidence of patients in need of antalgic palliative radiotherapy for bone metastasis was 140/per million. The SR with MA determined that MFR and SFR are equally effective in palliating bone pain with the same risks of complications. However SFR increases the need of re-treatment (RR=2.5; CI95% 1.76 to 3.56), or 19.9% for SFR versus 7.8% for MFR (level of evidence 1b). We calculated the cost of each treatment as MFR USD 2,456,11 /patient and SFR USD 1,734,98 /patient. The projected costs in a population of 1 million insured lives including re-treatment costs was USD 370,872,77 for MFR versus USD 291,476,66 for SFR. The difference of USD 79,396,11 represents USD 0,08/per life insured/per year. CONCLUSIONS: Since both types of radiotherapy are equally effective, and SFR provides an economy of USD 0.08 per life/per year, it should be the preferred choice.