OBJECTIVES:  The treatment outcomes of bevacizumab based therapy for HER2- metastatic breast cancer (MBC) patients were vastly already investigated within many controlled clinical trials. The objective of this study was to evaluate for the first time the cost-effectiveness of treating HER2- MBC patients in France, considering survival outcomes, based on a real world setting. METHODS:  A 3-health states partitioned survival model was considered. The clinical outcomes (progression free survival and overall survival) were derived from the real world ESME study performed by UNICANCER, for HER2- first line MBC patients. The outcomes of 2’127 and 1’299 patients treated respectively with bevacizumab+paclitaxel and with paclitaxel alone were considered. The health state utilities and the frequency of the adverse events were collected from the literature. French tariffs were applied for all costs, estimated from a collective perspective. A time horizon of 10 years and a discount rate of 4% for clinical and cost outcomes were used. The primary outcome was the incremental cost per quality-adjusted life year (€/QALY). Sub-group analyses for hormonal-receptor-positive and triple-negative patients were performed. RESULTS:  The treatment with bevacizumab+paclitaxel led to 56’721 €/QALY for all the patients, and to 49’749 and 66’874 €/QALY respectively for hormonal-receptor-positive and triple-negative patients. Univariate sensitivity analysis showed that the results were mostly influenced by PFS utility score and the cost of posterior line of treatment. The acceptability curve indicated that 80% of the results were under 86’000 €/QALY for all patients. CONCLUSIONS:  The results demonstrated that the treatment of HER2- MBC patients treated in first line with bevacizumab+paclitaxel could be considered as good value for money compared to paclitaxel alone in France, based on real-world clinical outcomes.