OBJECTIVE: Dacarbazine is routinely used as the first line treatment of disseminated malignant melanoma with brain metastases in Poland. A head – to - head randomized controlled trial (RCT) showed a clinical superiority of fotemustine over dacarbazine in this indication. At the same time patients' access to many innovative medicines in Poland is limited because of budgetary constraints. Even if an innovative medicine is more effective and cost-effective, it is not applied since it is more expensive for the health care budget. The main objective of this analysis is to verify whether an administration of fotemustine is economicly justified for the National Health Fund (NHF) – the public payer in Poland. METHODS: A cost-minimization analysis was carried out from the NHF point of view. Direct medical costs were divided according to accounting standards into two groups: cost of drugs and cost of hospitalization required in order to administer the drugs. The majority of unit prices used in calculations were derived from the official price list of the Pomeranian Sickness Fund (which is the NHF part now). Following clinical standards and the length of the RCT the time horizon is 26 weeks. RESULTS: The cost of fotemustine administered to one patient (€4700) is higher than the cost of dacarbazine (€676) by €4024. The cost of hospitalization necessary to administer dacarbazine amounts to €5884 and is higher than cost for fotemustine (€1284) by €4600. The total cost in fotemustine group amounts to €598 and was lower than cost of dacarbazine (€6560) by €576. CONCLUSION: Substitution of dacarbazine with fotemustine in the treatment of disseminated malignant melanoma with brain metastases is a good alternative not only for Polish patients (as clinically better) but also for the Polish NHF (as cost – saving). Ex. rate 1 € = 3.98 PLN