OBJECTIVES: Spaepen et al. (the Oncologist 2008;13:596–607) published a cost-analysis comparing darbepoetin alfa (DARB), epoetin alfa (EPO-A) and epoetin beta (EPO-B) in the treatment of chemotherapy-induced anemia, using propensity score matching. The study was performed using the IMS Hospital Disease Database, a longitudinal database unique to Belgium containing individual patient/admission-level data on diagnoses, procedures, and pharmaceuticals. Given the limited availability of other databases reporting the same level of information in other European countries, the objectives of this study were to assess the applicability of the Belgian analysis, and to estimate differences in costs between ESAs in Austria, Italy, Portugal, and Spain. METHODS: To adapt the analysis, costs were replaced with country-specific costs and discrepancies in epidemiology and treatment patterns were examined. Adjusting for country discrepancies, costs were analyzed using a mixed-effects model stratifying for propensity score quintiles as in Spaepen 2008. Sources included Eurostat, national cancer registries, IMS sales data, and reimbursement and treatment guidelines for procedures and drugs. RESULTS: All populations were comparable to Belgium in terms of age, gender, ESA use, and blood transfusions. Adjusting for chemotherapy use and tumor-specific cancer incidence, total costs (Euro, 2010) with DARB were 22-26% lower compared to EPO-A and 20-35% lower compared to EPO-B. Anemia-related costs were lowest for DARB €2,585±154, EPO-A €3,102±99, EPO-B €2,969±166 in Austria; DARB €3,144±211, EPO-A €5,049±119, EPO-B €3,656±230 in Italy; DARB €2,153±117, EPO-A €2,446±63, EPO-B €2,654±124 in Portugal; and DARB €2,378±143, EPO-A €3,349±75, EPO-B €2,857±153 in Spain. CONCLUSIONS: Total and anemia-related costs were lowest in patients receiving DARB compared to EPO-A or EPO-B in all countries. Although it was not possible to account for all differences among countries, the findings are in line with those from the Belgian analysis, and demonstrate the feasibility of adapting such data to other settings accounting for patient characteristics and treatment costs.