OBJECTIVES: To perform comparative pharmacoeconomic analysis of aprepitant plus standard antiemetic therapy – 5-hydroxytriptamine-3 antagonist and corticosteroid - for prevention chemotherapy-induced nausea and vomiting (CINV) versus standard antiemetic therapy. METHODS: Analysis of the published clinical trials was conducted to evaluate comparative efficacy and safety of three-drug combination. Cost-effectiveness analyses was performed. Direct medical costs of treatment with studied drugs were considering for each option: cost for 1-cycle and 6-cycle cancer chemotherapy (CCT) with highly emetogenic drugs (deWit R. et al., 2003) and for 1-cycle and 4-cycle CCT with moderately emetogenic drugs (Rapoport B. L. et al., 2010, Herrsted J. et al., 2005) for 1 patient. The calculation of costs was based on drugs’ priсes from the  List of Vital and Essential Drugs in Moscow region. The incremental cost-effectiveness ratio (ICER) was estimated. One-way sensitivity analysis was made. RESULTS: According to published trials the using aprepitant plus standard antiemetic therapy in patients receiving highly and moderately emetogenic chemotherapy was associated with a significant improvement in control of CINV. The ICER was 593.7 USD per 1-cycle and 2906.6 USD per 6-cycle CCT with highly emetogenic drugs for 1 patient. The ICER was 852.7 USD per 1-cycle and 4570.1 USD per 4-cycle CCT with moderately emetogenic therapy. The one-way sensitivity analysis showed that the results are more sensitive to the variations of aprepitant price. CONCLUSIONS: The using aprepitant plus standard antiemetic therapy was more effective and economically justified treatment option for prevention of nausea and vomiting associated with highly and moderately emetogenic cancer chemotherapy.