OBJECTIVE: To estimate the difference in total direct cost between daily filgrastim injections versus a single once-per-cycle pegfilgrastim injection over four cycles in France and Germany. METHOD: The perspective of analysis was that of the national health care services. A Markov model was used to estimate the total direct costs for neutropenia management over four chemotherapy cycles. Total costs included drug administration cost, drug acquisition cost, patient monitoring cost and febrile neutropenia (FN) management cost. Clinical data were obtained from a meta-analysis of two pivotal, randomised double-blind clinical trials comparing filgrastim and pegfilgrastim [Siena S et al. Oncol Rep 2003;10:715-24.]. The drug administration cost and patient monitoring cost were estimated using a time and motion method. The per cycle drug administration cost for filgrastim and pegfilgrastim was €155 and €14, respectively, in France and €530 and €67 in Germany. The per cycle drug acquisition cost for filgrastim and pegfilgrastim was assumed equal in both countries. In France, the per cycle monitoring cost for filgrastim and pegfilgrastim was €43 and €22, compared to €31 and €15 in Germany. The cost for managing FN in France was €2439 per episode and €1816 in Germany. RESULTS: In both countries, a once-per-cycle pegfilgrastim injection was less expensive than daily injections of filgrastim. The mean total cost for neutropenia management with filgrastim and pegfilgrastim was, respectively, €6056 and €5213 over four chemotherapy cycles in France, and €6449 and €4850 in Germany. The difference was mainly due to a lower FN rate in the pegfilgrastim group [11% vs. 19% in the filgrastim arm (p <0.05)] and a lower drug administration cost. CONCLUSION: Compared to filgrastim, the use of pegfilgrastim reduced the total cost for neutropenia management in France and Germany.