OBJECTIVE: Until recently, best supportive care (BSC) has been the only option for NSCLC patients who do not respond to first line platinum based chemotherapy. Docetaxel was recently approved by NICE for use in patients with locally advanced or metastatic lung cancer. This study modeled the incremental cost-effectiveness of docetaxel and BSC versus BSC alone, in terms of direct health-care costs per life year gained. METHOD: The model used the results of a published trial which directly compared docetaxel + BSC with BSC alone. The difference in mean survival between the docetaxel group and the BSC group was calculated as 3.82 months. Costs principally comprised drug acquisition and administration. In the reported trial result there were no costs for toxicity treatment or any cost offsets, because of incomplete trial data on non-chemotherapy treatments. However, a worst case was modeled, including possible toxicity treatment costs, and a best case, including possible cost offsets. Sensitivity analysis also varied months of life gained by taking the weighted average of the worst two survival results (worst case) and the best two survival results (best case) from four phase II trials. Patient mean body mass and the number of vials used to meet dose requirements were also varied. RESULTS: The model estimated a cost per life year gained of £13,618. (Best case £7,086; worst case £28,905). These cost-effectiveness ratios compare favourably to accepted standards in the UK. Whilst not captured in the model, the published study showed no significant difference between the docetaxel group and the BSC group in terms of quality of life, but all QoL parameters favoured the docetaxel arm. CONCLUSION: Docetaxel is a cost-effective treatment for pre-treated NSCLC in terms of survival, with a non-significant trend to improved quality of life compared to BSC.