OBJECTIVES: There have been several recent product launches for the treatment of metastatic castration resistant prostate cancer (mCRPC). The aim of this study was to assess the cost of mCRPC treatments across the EU5 (France, Germany, Italy, Spain, UK) in relation to overall survival (OS), to determine if payers equally value the cost/ OS month for mCRPC treatments. METHODS: Median OS (total and gain vs control arm) and average treatment duration were extracted from Phase III trial data for Zytiga, Xtandi, Jevtana, and docetaxel for each approved indication. Launch prices were extracted from publically available sources. The cost/total OS month and cost/ OS month gained over control for each treatment, across the EU5, were then calculated. RESULTS: Based on total OS, docetaxel consistently offered the lowest cost/OS month across the EU5 with a median cost of €531/ OS month. For post-chemotherapy indications, Zytiga had the highest cost/OS month (€1820-€2904) in all countries except Italy, where Xtandi was higher (€3620). In contrast, for the pre-chemotherapy indications ,Xtandi had the highest cost/OS month (€1839 - €4112) across the EU5. When comparing price/OS month gained over control, there was significant variation across products. For example, the EU5 median cost/OS month were significantly higher for the pre-chemotherapy indications for Zytiga and Xtandi (€12,869 and €27,281 respectively) versus their post-chemotherapy indications (€7136 and €6252 respectively). Jevtana’s EU5 median cost of €11,322, for post-chemotherapy, was comparable to the cost/OS month gained over control for the pre-chemotherapy indications of Zytiga and Xtandi. CONCLUSIONS: Payers do not equally value cost/OS month, as observed by the range of costs/OS month across products. Similarly, there is significant variation in the price/OS month gained over control, with payers paying significantly more for the pre-chemotherapy compared to post-chemotherapy indications, inferring that payers maybe willing to pay more for treatments earlier in the treatment pathway for mCRPC.