OBJECTIVES: The management of metastatic castration-resistant prostate cancer (mCRPC) is complex and the associated drug treatments are increasingly costly. The treatment options for mCRPC include mitoxantrone, cabazitaxel, abiraterone and enzalutamide. The objective of our current study to evaluate the cost effectiveness and estimate the cost of drug treatments over the mCRPC period, in the context of the latest evidence-based approaches. METHODS: A decision-tree model compared four treatment options for mCRPC patients over 18 months from a 2015 Kazakhstan payer’s perspective. The decision model included; baseline pain level as a measure for disease severity, development of treatment specific side effects and treatment specific survival. Data on probabilities life expectancies and utilities were obtained from clinical trial data (COU-AA, AFFIRM, Tropic) and other published sources. The cost parameters were incorporated from the following categories: drug treatment, radiation therapy, therapy-specific side effects, and death. Probabilistic sensitivity analyses, acceptability curves and net benefit calculations were performed. RESULTS: Based on case analysis, cabazitaxel therapy was the most expensive ($133897), followed by enzalutamide ($129,348), abiraterone while ($118,620), mitoxantrone ($92,115). Quality adjusted life expectancy was highest with cabazitaxel (0.74 QALY), followed by abiraterone (0.69 QALY), mitoxantrone (0.57 QALY), enzalutamide (0.54 QALY). Mitoxantrone was found to be the most cost effective treatment ($50,866/QALYs) compared to prednisolone.  At a willingness to pay of $100,000/QALY, the cost effectiveness acceptability curves showed that mitoxantrone and abiraterone were cost effective 22.9% and 24.1% times respectively. CONCLUSIONS: This is study estimates the direct drug costs associated with mCRPC treatments in the Kazakhstan healthcare system. Treatment of mCRPC with recently developed therapies can extend the survival, however, the gains in survival are accompanied by significant costs with abiraterone, cabazitaxel and enzalutamide.  At 2015 prices, mitoxantrone which has a lower side effect profile appears would be cost effective at conventional willingness to pay thresholds.