OBJECTIVES: Invasive aspergillosis (IA) is a major infectious complication in inmonusupressed patients.  Its incidence ranges from 5 percent to more than 20 percent in high-risk groups.  The aim of this study was to assess the cost-effectiveness (CE) of voriconazol, amphotericin B and caspofungin as first line treatments for IA adult inmunosupressed patients in Dominican Republic, from the public healthcare perspective.  METHODS:  A decision-tree model was used to compare costs and effectiveness of amphotericin B (basecase) IV (15mg/kg/day), caspofungin IV (Initial dosage 70mg/day, maintenance dosage 50mg/day) and voriconazole IV (12mg/kg/day).  Effectiveness measures were: clinical success rates, mortality rates, intensive care unit (ICU) length of stay (LOS) and hospital ward LOS. Effectiveness and epidemiologic data, was collected from published literature. Local public costs (2011 US$) were obtained from Dominican Republic´s Social Security official databases. The model used a 12-week time horizon and only direct medical costs were considered. Monte Carlo probabilistic sensitivity analysis (PSA) was constructed. RESULTS: Voriconazole resulted as the least expensive and most effective option for IA patients. Clinical success rate was higher with voriconazole (56.6%) compared with amphotericin B (36.4%) and caspofungin (34.2%).  Mortality rates were: 34.1% with voriconazole, 50.9% with amphotericin B and 44.7% with caspofungin. Considering ICU LOS against voriconazole, LOS resulted 2.22 and 2.35 days higher with amphotericin B and caspofungin, respectively. Hospital ward LOS was also higher with amphotericine B (16.4 days) and caspofungina (16.5 days) against voriconazole (15.4 days). Overall medical costs were: US$26,078.22 with voriconazole, US$29,240.17 with amphotericin B and US$33,514.01 with caspofungin.  Cost effectiveness analyses showed voriconazole as the cost-saving strategy. PSA outcomes support the robustness of these findings.  CONCLUSIONS: This is the first CE study for IA developed in Dominican Republic within the public sector. Voriconazole would generate savings over US$3000 per patient in the Dominican’s clinical public context.