OBJECTIVES: Assess whether the use of Erlotinib as 1st line treatment in metastatic or advanced Non Small Cell Lung Cancer (NSCLC) patients with Epidermal Growth Factor Receptor (EGFR) mutation positive, is a dominant alternative from the perspective of public health system in Mexico. METHODS: It was developed a cost-utility analysis using a Markov model with monthly cycles stages: response to treatment, stable disease, disease progression and death in a time horizon of 5 years. The costing method is the direct medical costs and the main outcome measures were QALY's and total cost of treatment per patient. The drugs compared in the study were Erlotinib, Gefitinib and chemotherapy with Gemcitabine plus Carboplatin. Costs are expressed in US dollars. RESULTS: Erlotinib was the alternative that provided a greater number of QALY's (1.49) compared with Gefitinib (1.32) and chemotherapy with Carboplatin (1.07). Furthermore, treatment with Erlotinib was the least expensive with a cost per patient of $51,249 on a horizon of 5 years while the cost of Gefitinib was $ 53,817 per patient and the QT with Gemcitabine + Carboplatin $53,258 per patient. This implies that the dominant treatment for these patients (NSCLC and positive EGFR mutation) is Erlotinib with a cost-effectiveness average of $34,456. The dominance results of treatment with Erlotinib were consistent with sensitivity analysis, which provides robustness to the results. CONCLUSIONS: Considering the average annual costs, Erlotinib represents savings for the health sector from $402 (versus Gemcitabine + Carboplatin) to $514 (vs Gefitinib) for each patient according to its comparator in 1 year. Therefore, under the context of public health system in Mexico, treatment with Erlotinib was shown to be a cost-effective treatment and dominant over other treatment alternatives considered in this study for patients with NSCLC and EGFR mutation.