OBJECTIVES:  Intravenous (IV) iron and erythropoiesis-stimulating agents (ESAs) are used in the management of anemia in hemodialysis (HD) patients. The interchangeability of IV iron sucrose (IS) preparations is questioned in the literature. We evaluated the outcome and the cost of switching from an original IS to a IS similar (ISS). METHODS:  A cost outcome analysis was conducted from a French hospital perspective. A 1-year time horizon was used. A monocentric sequential observational study in stable hemodialysis (HD) patients compared two 5.5-month periods, separated by a wash-out period during one month. Original IS and ISS were administered respectively during the first (P1) and the second (P2) periods. Clinical outcomes were assessed by anemia parameters, number of transfused patients and doses of ESA and IV irons. The main endpoint was the difference of hemoglobin (Hb) levels between P1 and P2. Anemia-related treatment acquisition costs were considered. A nonparametric bootstrap method assessed the robustness of results. RESULTS:  A total of 105 patients were included in this cohortMean hemoglobin level was 10.93 ± 1.01 g/dL during P1 and 10.94 ± 0.95 g/dL during P2 (p=0.97). The monthly average dose of IV iron per patient was 248.31 ± 158.18 mg/month in P1 and 259.74 ± 158.92 mg/month in P2 (p=0.39). The mean dose of ESA was 0.46 ± 0.51 UI/kg/week in P1 and 0.59 ± 0.60 UI/kg/week in P2 (p= 0.005). Nine and 8 patients were transfused respectively in P1 and P2 (p=0.02). The mean cost-difference per patient between P1 and P2 was + 14.11 €. Anemia-related treatment acquisition costs were higher in P2 in 100% of simulations. CONCLUSIONS: In this population, ISS was as effective as original IS based on the main endpoint but was not cost-saving. Further investigation with a longer time horizon is needed.