OBJECTIVES: Metastatic prostate cancer (MPC) results from the spread of cancer to distant parts of the body and is associated with markedly decreased survival. First line therapy for prostate cancer involves androgen deprivation, however most MPC patients progress in spite of castration levels of testosterone. A recently approved infusion product, Radium Ra 223 dichloride (Radium-223), has been introduced in the U.S. market adding to concerns about the costs for end-stage treatments. We sought to estimate the budget impact of Radium-223 on infusion center expenses in the U.S. METHODS: We developed a financial model to estimate budget impact from a hospital-based infusion center perspective. Using data from the U.S. Census, SEER, and the Premier Perspective Database, we estimated the eligible population using a theoretical hospital’s catchment area. We modeled use, treatment costs and reimbursement for three radiopharmaceuticals (Radium-223, Samarium-153, and Strontium-89) and two common chemotherapies (docetaxel and cabazitazel) in terms of drug cost, infusions, and laboratory monitoring. Reimbursement for these treatments was estimated at both commercial and Medicare rates using the Average Sale Price and relevant Common Procedural Technology codes. We calculated total cost and reimbursement for one year with the current utilization from Premier and then estimated the incremental net budget impact associated with adoption of Radium-223 at 1, 3, and 5% of patients. RESULTS: In a catchment area of 1 million lives, an estimated 45 MPC patients with non-visceral bone metastases would be treated with current agents and incur approximately $500,000 in treatment costs for radiopharmaceuticals and chemotherapy. Adding Radium-223 to the treatment mix and assuming adoption rates of 1% to 5%, the annual net impact on the infusion center budget would range from $600 to $3,000. CONCLUSIONS: Radium-223 presents a new treatment option for MPC patients with non-visceral bone metastases and a positive net impact for infusion centers.