OBJECTIVES: Massive pulmonary embolism (PE) is a life-threatening condition associated with a high incidence of fatalities comparable to that of acute myocardial infarction. A variety of treatment modalities have been used in patients with massive PE, which include systemic anticoagulation, catheter-directed thrombolysis (CDT) and etc. METHODS: A Markov model was constructed to determine the costs and benefits of CDT with urokinase and CDT with alteplase. The time horizon of the model was lifetime, and a monthly cycle length was adopted.  A review of the literature was undertaken to identify the primary studies used to populate the decision model. Direct medical costs were assessed from the payer perspective in the Kazakhstan and analyzed using sensitivity analyses. A Monte Carlo analysis with 1000 patients was performed to obtain mean. RESULTS: Compared with heparin, CDT was associated with a significant reduction of overall mortality. This reduction was not statistically significant after exclusion of studies including highrisk PE. However, major haemorrhage and fatal or intracranial bleeding were significantly more frequent among patients receiving CDT. The multi-way sensitivity analysis showed that CDT was cost-effective only under specific scenarios. The expected costs per patient were $1,656 for CDT with urokinase and $990 for CDT with alteplase (difference $666). The mean cost-effectiveness ratio was $235,950 per CDT with urokinase  and  $487,229 for CDT with alteplase. Probabilistic sensitivity analysis showed that CDT with urokinase was more effective and less costly (dominant) in 23% of all simulations.  CONCLUSIONS: The analysis showed that CDT might be cost-effective in sub-groups of patients at high risk of death from PE.The use of CDT with urokinase for the treatment of haemodynamically stable patients with PE was more cost-effective than CDT with alteplase in the Kazakhstan. The fact that when using alteplase have a higher risk of hemorrhage than with urokinase is also preferences for the use of urokinase for CDT.