OBJECTIVES:  we conduct a cost-effectiveness evaluation of long-acting (pegfilgrastim) and short-acting (filgrastim/lenograstim) granulocyte colony–stimulating factors (G-CSFs) for the prevention of febrile neutropenia (FN) in patient with breast cancer (BC) and high risk of FN (more than 20%) in Russia. METHODS: Markov model was used to estimate the effectiveness (20-year overall survival) and costs of four strategies FN primary prophylaxis (6 cycles): single-administration pegfilgrastim versus daily filgrastim/lenograstim (6-days real practice regimen) and no G-CSF. Markov model was constructed to simulate cancer survival, which was determinate by sub-optimal dose intensity chemotherapy (FN lead to reduce/cancel of CB chemotherapy). Costs were taken from Russian health care databases (2015 year 1 USD - 60.9579). One way sensitivity analysis was performed to examine the stability of the results. RESULTS:  a search of the Medline and Cochrane Library database 2000-2015 was performed, finally 3 from 160 papers were selected for Markov cohort simulation. Cancer survival (associated with dose intensity chemotherapy) was 10.2, 10.0 и 9.5 for pegfilgrastim, filgrastim/lenograstim and no G-CSF prophylaxis respectively. Pegfilgrastim is dominated strategy for primary FN versus lenograstim. Pegfilgrastim is more costly, but more effective treatment versus filgrastim and no G-CSF prophylaxis - ICER per life years gained (LYG) was calculated at 3,407- 4,087 USD. Our estimates fall below the Russian willingness to pay (WTP) threshold of 27,150 USD per LYG. Sensitivity analyses showed that results were non sensitive to mean age of patients, costs of health care resource use (±20%), discount rates (0-10%) and was sensitive to price on pegfilgrastim (±20%). CONCLUSIONS: pegfilgrastim FN prophylaxis is associated with a lower risk of hospitalization of cancer patients than filgrastim/lenograstim or no G-CSF prophylaxis with baseline FN risks greater than 20%. Pegfilgrastim is dominated versus lenograstim and cost-effectiveness versus filgrastim and no G-CSF regimen, ICER is less than WTP threshold.