OBJECTIVES:  Administration of erythropoiesis stimulating agent (Epoetin alpha or Darbepoietin alpha) is the standard of care for treatment of anemia in hemodialysis (CKD5D) patients. The Pharmacoeconomics of this therapy is important in developing countries since most of the patients are on self-funding for medications. This study was conducted to compare cost per patient and clinical efficacy of these agents in CKD5D patients METHODS: A retrospective study was conducted for a period of one year (January – December 2016) on stable CKD5D patients receiving regular erythropoietin treatment (Epoetin alpha or Darbepoietin alpha) at a tertiary care hemodialysis center in India. Patients with gastrointestinal bleeding, cancer, iron deficiency, pure red aplasia, hemolytic anemias and non-compliant were excluded. The baseline characteristics were compared between the Erythropoietin alpha (E) and Darbepoietin (D) groups. The E group received 4000 Units subcutaneous (S.C) Epoetin alpha and the (D) group received Darbepoietin 40 units S.C once weekly. The maintenance dose and intravenous iron were continued as per clinician discretion. At the end of one year the mean hemoglobin levels (HgB) and cost per patient for drug were compared between the groups. The statistical analysis was done using SPSS version 15. RESULTS: There were 29 patients in E group and 23 in D group. The baseline characteristics were comparable. The average HgB level over one year was the 9.71 ± 1.43 g/dl in E group and 9.73 ± 0.98 g/dl in D group (p=0.942) suggestive of similar efficacy. There was a significant difference in the mean costs per patient per year for Erythropoietin alpha (30075.86 ± 2392.04 INR) and Darbepoetin (69843.47 ± 6660.31 INR) (p=0.001). CONCLUSIONS: Epoetin alfa has a better pharmacoeconomic value compared to Darbepoietin in maintaining Hemoglobin levels in CKD5D patients with similar clinical efficacy. It needs large prospective randomized trials to obtain more definitive data.