OBJECTIVES: Patients with chronic kidney disease (CKD) mainly develops anemia from decreased renal synthesis of erythropoietin. Erythropoiesis-stimulating agents are the recommended therapy for those patients. The aim of this study was to determine the cost-effectiveness of Darbepoetin alfa (DARB) versus Epoetin alfa (EPO) in treating anemic patients with CKD from the health insurance perspective over a time horizon of five years. METHODS: A half cycle corrected Markov model comprising 4 health states (low hemoglobin level, target hemoglobin level, high hemoglobin level and death) was developed to estimate the projected clinical and economic implications of both treatment strategy. The clinical parameters were derived from published randomized clinical trials. The utility of the health states was derived using the available published data. Direct medical costs were obtained from the Ministry of health hospitals in Egypt. One way sensitivity analyses were conducted and all variables were varied with a range of ±10%. RESULTS: Total costs for DARB and EPO were EGP 122,921 and EGP 357,662, respectively. QALYs for DARB and were 13.053 and 12.751 respectively. The incremental cost-effectiveness ratio (ICER) for DARB versus EPO was L.E -776,977 EGP/QALY. This study showed that DARB is a cost saving choice compared to EPO in the maintaining of hemoglobin target level in hemodialysis patients. One way sensitivity analysis showed that the utility of patients with target hemoglobin has the greatest impact on the results. CONCLUSIONS: Darbepoetin alfa is a cost-saving strategy compared to Epoetin alfa in anemic patients with CKD from the health insurance perspective.