OBJECTIVES: The aim of this study is to assess efficiency of adding rituximab to fludarabine and cyclophosphamide (R-FC versus FC) for the treatment of previously untreated chronic lymphocytic leukemia in Ukraine.  METHODS: A cost-effectiveness analysis was performed from a health care perspective over a 20 year horizon with 3% discounting rate. Markov model in Excel program (2007) with cohort simulation was applied. Three-state model (no disease progress, relapse, and death) was run using one month cycle time. The outcome data were retrieved from a randomized controlled trial publication. One-way sensitivity analysis was performed to assess robustness of the results.  RESULTS: The incremental life expectancy increase was 3.27 months on R-FC in comparison to FC scheme. The expected costs associated with FC scheme are equal to $28,105 and with FC-R scheme to $41,850. R-FC was associated with incremental 1.3 quality-adjusted life-years (QALYs) compared to FC and resulted in an incremental cost-effectiveness ratio of $10,588 per QALY from health care perspective. Results were the most sensitive to unit drug cost for rituximab (costs deviation $1.77-3.88 per mg).  CONCLUSIONS: The World Health Organization recommends to consider drugs cost-effective if their incremental cost per QALY is less than 3 gross domestic product per capita in the country ($6,700/per capita in Ukraine). Under these recommendations, R-FC scheme is seen as cost-effective in Ukrainian health-care setting.