OBJECTIVES: To assess the cost-effectiveness of Bendamustine-Rituximab (BR) compared with Fludarabine-Rituximab (FR) treatment, in patients with Indolent Non-Hodgkin’s Lymphoma (INHL) that have progressed during or within six months of treatment with Rituximab or a Rituximab-containing Regimen in Panamá. METHODS: A three-health state cohort simulation Markov Model (progression-free, progressive disease, and death) was developed, based on time-dependent progression-free survival and overall survival data. The time frame was lifetime (35 years). The perspective was that of the National Health System of Panamá. The health outcomes of interest were Quality Adjusted Life Years (QALYs), Life Years (LYs), and Progression-free Life Years (PFLYs). Resource consumption for health states was elicited with the support of Latin American hematologists. Utilities for health states and disutility for adverse reactions were taken from published studies. All costs and Incremental Cost Effectiveness Ratios (ICERs) are presented in United States Dollars. Costs and outcomes were discounted at 3%. One way and probabilistic sensitivity (PSA) analysis were performed. RESULTS: BR resulted in 4,641 QALYs/ 6,432 LYs/ and 3,564 PFLYs, per patient, respectively. FR resulted in 3,557 QALYs/5,138 LYs and 2,047 PFLYs, per patient, respectively. Total costs were: 140.768 for BR and 125.097 for FR. ICERs were: 14.468 per QALY gained, 12.114 per LY gained and 10.331 per PFLY gained. In all outcomes, results were sensitive to Hazard Ratio of overall survival. According to the PSA, with QALYs as outcome, BR had a probability of 39% of being cost effective when considering the threshold of 3 times the Gross Domestic Product per capita (GDPPC) of Panamá (28.602). CONCLUSIONS: BR can be considered cost-effective compared with FR in the study population (INHL) in Panamá, according to the classification suggested by the World Health Organization [cost effective between 1 and 3 GDPPC (9534-28602)].