OBJECTIVES: To conduct an economic evaluation comparing pegfilgrastim with filgrastim or lenograstim used either in an 11-day regimen or in a 6-day regimen for the prophylaxis of febrile neutropenia (FN) in breast cancer patients, in the Greek healthcare setting. METHODS: A cost-effectiveness model was locally adapted from the public third-party-payer perspective. Efficacy and utility values extracted from published studies were considered in the model. The analysis was conducted for a 6-cycle horizon, to reflect the common clinical practice in Greece. Drug acquisition costs, administration costs and FN management reimbursed costs were considered (in €2014). The outcomes of the model were the incremental cost per additional FN event avoided and per QALY gained (ICER) of pegfilgrastim to its comparators. The ICERs were evaluated at the predetermined willingness-to-pay threshold of €34,000/QALY gained. RESULTS: The incremental cost per additional FN event avoided with pegfilgrastim ranged between €11,015 and €27,079 compared to 11-day regimens of originator and a biosimilar filgrastim respectively, while pegfilgrastim was found to be dominant compared to the 11-day regimen of lenograstim. Comparing pegfilgrastim with the 6-day regimen of filgrastim and lenograstim, it was found that the ICER per additional FN event avoided ranged between €9,538 and €15,207 in case of lenograstim and  biosimilar filgrastim respectively. Similarly, cost-utility analysis revealed that pegfilgrastim was cost-effective over 11-day and 6-day regimens of originator filgrastim with ICERs of €11,065 and €19,942/QALY gained, respectively. Compared to lenograstim, pegfilgrastim was found to be dominant over the 11-day regimen and cost-effective over the 6-day regimen (ICER: €15,546).   CONCLUSIONS: Our findings suggests that pegfilgrastim for the prophylaxis of chemotherapy-induced FN in breast cancer patients is associated with greater health benefit and lower cost over 11-day use of lenograstim, while it is a cost-effective option over either the 6-day or the 11-day regimen of biosimilar filgrastim, in Greece.