OBJECTIVES:  Colorectal cancer is the third most common tumour and the fourth most frequent cause of death worldwide. Several cytotoxic agents are available to be used as single agents or in combination regimens such as folinic acid/5-FU/oxaliplatin (FOLFOX), folinic acid/5-FU/irinotecan (FOLFIRI) and capecitabine/oxaliplatin (XELOX). Biologic drugs as bevacizumab, cetuximab and panitumumab, in combination with chemotherapy are also approved for the treatment of mCRC. The objective of this study was to compare treatment costs of first-line regimens for mCRC in Italy. METHODS: A set of first-line regimens was considered, based on the AIOM (Associazione Italiana di Oncologia Medica) and ESMO (European Society of Medical Oncology) guidelines. A targeted review of the literature was undertaken to identify clinical study references for treatment regimens, detailing doses and administration frequencies. The total cost of a regimen was calculated as the sum of drug, administration and adverse events costs, based on current prices and tariffs. Information on treatment duration was only available in few published clinical studies. To avoid introducing bias, treatment duration was assumed fixed among all regimens, and equal to 6.1 months, on the basis of the published opinion of a clinical experts panel. RESULTS:  Bevacizumab 7.5mg+capecitabine was the least expensive regimen, with a total cost of €16,754 per patient. Among the regimens that associated a biologic to FOLFOX, bevacizumab 5mg+FOLFOX4 was the least expensive (€32,709 per patient), compared to panitumumab+FOLFOX4 (€42,815), cetuximab+FOLFOX4 (€42,725), and cetuximab+FOLFOX (€37,995). In the association with FOLFIRI bevacizumab was less expensive than cetuximab (€28,389 for bevacizumab5mg+FOLFIRI and €35,310 for cetuximab+FOLFIRI). CONCLUSIONS:  From the economic perspective of the Italian NHS, bevacizumab appears to be a convenient option among the first-line regimens for mCRC. Further study, based on real-world evidence, would be necessary to confirm this result.