OBJECTIVES: Castration resistant prostate cancer with bone metastases (mCRPC) is a common condition associated with high medical and indirect healthcare costs. Purpose of this analysis is to estimate the economic consequences of Radio-223 dichloride in the treatment of prostate cancer with definition of a Budget Impact Analysis (BIA) from the perspective of the National Health Service (NHS). METHODS: Budget Impact analysis was carried to quantify the impact on the Italian National Health Service, in terms of costs of treatment given to the castration resistant prostate cancer (mCRPC), and as a result of the introduction of Radio-223 dichloride. In the assessment it was assumed that all the formulations present the same effect, ie that they present the same probability of efficacy in the treatment of metastatic castration resistant prostate cancer. The calculated values were applied to a population with mCRPC estimated the first year by about 4,009 people. RESULTS: Considering the cost of the drug, the costs of administration, the cost of each adverse event, the total costs of each therapy, Radio-223 dichloride appears to have a lower cost than Abiraterone in both setting of patients in the first and second line treatment, lower than Enzalutamide in post-docetaxel population. The total costs were as follows: Radio-223 dichloride € 24,662.13; Abiraterone pre-Docetaxel € 54,112.25, € 28,490.63 Abitaterone post-docetaxel, Cabazitaxel € 26,995.20, Enzalutamide € 30,885.55 and finally Docetaxel € 4,574.69. Overall, looking at the scenario of the 1st and 2nd line following the introduction of Radio-223 dichloride it would generate savings of € 1,467,994 the first year, € 3,545,090 in the second year and finally € 7,660,642 in the third year. CONCLUSIONS: Treatment with Radio-223 dichloride turns out to have a favorable impact on the budget and appears to be the less expensive compared to other therapeutic strategies used in mCRPC in Italy.