BACKGROUND:  Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in people over the age of sixty in Russia. Costs associated with treatment are important for decision makers in healthcare. OBJECTIVES: To conduct cost analysis of aflibercept (AFL) vs ranibizumab (RBZ) in patients with wet AMD for Russian healthcare setting. METHODS: Randomized clinical trials (RCT) showed equal efficacy for the AFL and the RBZ in patients with wet AMD with a fewer injections of AFL. A decision tree was constructed to calculate direct medical costs associated with wet AMD for 2 years. Endpoints were death, treatment success or treatment failure, followed by laser photocoagulation; all probabilities were taken from relevant RCT. Costs were calculated on the basis of registered maximal manufactures’ drug prices and tariffs of state healthcare system. Probabilistic sensitivity analysis was conducted. Probabilities of all patient conditions, number of drugs injections and costs of medical services were used as variables in the sensitivity analyses. RESULTS: AFL is less costly than RBZ. The difference in costs in favor of AFL amounted to €1,584 EUR per 1 patient per 2 years (7,800 and 9,384 EUR, for AFL and RBZ respectively). The main factor affecting the results of the baseline scenario was a fewer AFL injections over 2 years of treatment. In the sensitivity analysis the probability of AFL domination was 73%. CONCLUSIONS: AFL seems to be a cost-saving option compared with RBZ with a similar efficacy for Russian healthcare.