OBJECTIVES: Enzalutamide, abiraterone acetate plus prednisone and cabazitaxel plus prednisone (hereafter referred to as abiraterone and cabazitaxel, respectively) are approved for the post-chemotherapy treatment of metastatic castration-resistant prostate cancer (mCRPC) in Russia. Currently, none of these treatments are included in the Government Drug Reimbursement Program (GDRP), which limits accessibility to these established and effective therapies for patients with limited treatment options. This pharmacoeconomic evaluation compared enzalutamide, abiraterone and cabazitaxel used after chemotherapy in patients with mCRPC from the Russian healthcare system perspective. METHODS: Based on AFFIRM (enzalutamide), COU­AA­301 (abiraterone) and TROPIC (cabazitaxel) data and indirect comparisons of considered drugs, we proposed an mCRPC Markov chain model and calculated medical costs (medications, administration, adverse events treatments, treatments of bone metastases, pain relief, oncologist visits and palliative care) associated with three options. We used the 5-year time horizon as proposed by the national guidelines for pharmacoeconomic research. Budget impact, cost-effectiveness and cost-utility analyses were conducted. RESULTS: Use of enzalutamide, abiraterone and cabazitaxel resulted in 1.04, 0.94 and 0.96 quality-adjusted life years, respectively. Monthly medication costs for enzalutamide were US$2973 per patient, 15% less than for abiraterone and 49% less than for cabazitaxel. Five-year total medical costs were US$53,959, US$53,975 and US$71,836 per patient for enzalutamide, abiraterone and cabazitaxel, respectively. The smaller difference in total medical costs resulted from longer progression-free survival on enzalutamide compared to abiraterone or cabazitaxel. If included in GDRP, enzalutamide results in the lowest budget impact: US$105.70 million, compared to US$105.73 million for abiraterone and US$140.72 million for cabazitaxel. CONCLUSIONS: Enzalutamide is more effective compared to abiraterone and cabazitaxel and requires the same or less additional budget expenditure in Russia.