OBJECTIVES: To estimate budget impact in public health care system in Mexico with the use of cabazitaxel in the treatment of metastatic castration-resistant prostate cancer (MCRPC) progressing after Docetaxel regimen.  METHODS: A risk sharing model based on clinical performance of a hypothetical cohort of MCRPC patients treated with cabazitaxel was evaluated. The cut-off point was determined by median progression free survival (according to RECIST parameters) reported in TROPIC study. An exponential distribution of patients was simulated on a 30-week period with a cross sectional study approach considering clinical outcomes for every 3 weeks, a matrix of probabilities of transition was created. Median PFS was reported to be 2.8, a cohort of 50 patients was evaluated and a length of 10 cycles was assessed. The model considered a reimbursement to the institutions when a patient does not reach PFS reported on TROPIC study. Direct cost and an institutional perspective were considered. No discount rate was included.   RESULTS: Estimated budget impact for public institutions to cut-off point was estimated in 861,600 USD, with a total investment of 1.2 million USD for the estimated number of patients reaching 10 cycles. Reimbursement based on clinical performance was estimated in 310,200 USD. Calculated number of patients reaching PFS clinical value was 22 patients. Total annual expenditure for public health care institutions of cabazitaxel usage under risk sharing scheme, represents 0.002% of public budget for health care system and 0.032% of assigned budget for therapeutic goods in main public health care institution in Mexico. CONCLUSIONS: Treatment of MCRPC patients with Cabazitaxel under a risk sharing agreement may allow patients to obtain clinical benefits with a low economic impact to public institutions due to the low number of expected patients. Novel schemes for end-of-life treatments must be evaluated in order to assess potential benefits for patients/institutions.