OBJECTIVE: To evaluate from the payer’s perspective the cost-effectiveness of adding the NK1 receptor antagonist aprepitant to ondansetron/dexamethasone in patients undergoing highly emetogenic chemotherapy in office-based settings in Germany. METHODS: We compared aprepitant in combination with ondansetron/dexamethasone to ondansetron/dexamethasone alone over a single chemotherapy cycle. To that end a decision-analytic model based on clinical results and resource utilization observed in aprepitant Phase III trials was constructed. Health outcomes included complete response (no emesis, no rescue therapy) and quality-adjusted life years (QALYs). Utility values were obtained from the literature. German tariffs and prices were used to cost health care resources. A series of sensitivity analyses was conducted. RESULTS: In the aprepitant group (N = 514) 68% of the patients were complete responders over the entire chemotherapy cycle compared to 48% in the standard care group (N = 518). More patients were emesis-free over the entire chemotherapy cycle with aprepitant regimen (72%) compared to standard regimen (49%). Cost difference between aprepitant regimen and standard therapy was 37€, with 43% of the aprepitant drug cost being offset by lower resource use in the aprepitant group. Incremental cost per QALY gained with aprepitant was 21,764€. Results were most sensitive to costs of hospitalizations and rescue medications. CONCLUSIONS: Significantly more patients were estimated being emesis-free when adding aprepitant to antiemetic standard therapy, with a significant proportion of the cost of aprepitant being offset. Use of aprepitant in office-based settings in Germany proved to be cost-effective.