OBJECTIVES: Aspergillosis is the second cause of invasive fungal infections with high mortality rates. The objective of this research is to evaluate the cost-effectiveness of amphotericin B(AB) 1.5mg/kg/day, amphotericin B liposomal(AL) 3mg/kg/day, caspofungin(CA) 50mg/day,  voriconazol 8mg/kg/day(VO) including maintenance oral Voriconazol 400mg/day scheme in the treatment of aspergillosis  under the Brazilian private healthcare system perspective. METHODS: A decision tree model was built considering sequential treatments, from which patients could respond to one initial treatment and continue to a maintenance phase of the same medication, or do not respond due to either inefficacy or adverse events and switch treatments with assumed equal chance to use one of the other options. Effectiveness measures were mortality, clinical response and days of hospitalization, calculated by indirect comparison of a literature systematic review. Only direct costs were considered, and were obtained from CFM/CBHPM2010 for medical procedures, MOH/CMED December2012 price list for medications, and BRASINDICE for materials. Values were represented in 2012USD. A time horizon no longer than 4 weeks was considered, thus discounting was not applied. One-way sensitivity analysis considered de-hospitalization in maintenance phases while using oral voriconazol. RESULTS: Clinical response rates were 36.40%(AB), 34.60%(AL), 34.20%(CA), 56.67%(VO), mortality rates were 50.90%(AB), 48.70%(AL), 44.70%(CA), 34.10%(VO) and hospitalization days were 26.35(AB), 24.68(AL), 25.33(CA), 22.55(VO). Expected treatment costs were US$33,838.33(AB), US$71,186.24(AL), US$46,223.28(CA) and US$36,255.09(VO). Considering AB as the baseline for cost-effectiveness, VO presented an incremental cost-effectiveness ratio(ICER) of 26,723.07 while other options were dominated with higher costs and lower effectiveness. If de-hospitalization was considered, VO would sum 14.62 hospitalization days, treatment cost of US$32,755.71 and an ICER of US$9,459.23. CONCLUSIONS: Assuming a willingness to pay of US$32,621.93 (3 times the Brazilian 2011GDP per capita), VO was the only cost-effective option compared to AB, additionally presenting lower mortality and less hospitalization days while allowing early de-hospitalization at private healthcare services.