OBJECTIVES: Currently imatinib is the most widely used drug for treatment of chronic myeloid leukemia (CML) in Russia, however some patients are resistant or intolerant to it. Nilotinib, dasatinib and bosutinib are available for these patients, however only dasatinib is included in the Government Drug Reimbursement Program (GDRP), which limits accessibility to other drugs. The aim of the current paper is to conduct pharmacoeconomic evaluation of nilotinib, dasatinib and bosutinib for the 2^nd line CML drug therapy from the Russian healthcare system perspective. METHODS: We proposed Markov model of CML progression on nilotinib, dasatinib or bosutinib 2^nd line therapy. Model included 5 states: 2^nd line treatment, discontinuation, acceleration phase, blast crisis and death. Transition probabilities were derived from the clinical trials of considered drugs. Due to limited clinical data availability we used 4-year time horizon. Model was used to calculate per patient medical costs, including medication costs, adverse events treatment, inpatient and outpatient care. Cost-effectiveness and budget impact analyses were conducted. RESULTS: During 4-year modeling period life-years gained on nilotinib, dasatinib and bosutinib were 3.66, 3.56 and 3.68, respectively. Monthly medication costs of nilotinib were US$2,626, which were $54 (2.0%) less, compared to dasatinib and US$1,011 (27.8%) less compared to bosutinib. 4-year total medical costs of nilotinib were US$70,336, or 13.9% less compared to dasatinib and 37.3% less compared to bosutinib. Nilotinib also had the lowest cost / effectiveness ratio. If 996 patients have access to nilotinib through Government Drug Reimbursement Program, 4-year budget spending will be US$12.4 million less compared to dasatinib. CONCLUSIONS: Being comparably effective, nilotinib is the cost-saving option for the 2^nd line CML treatment compared to dasatinib and bosutinib in Russian healthcare circumstances.