OBJECTIVE: Estimate and compare resource use and costs associated with RBC transfusions in the management of anaemia among cancer patients treated with chemotherapy in one French and one Austrian setting. METHOD: The same ABC study protocol was used: structured interviews were held with key personnel at the oncology ward to obtain a detailed overview of the activities, frequencies, resource use and related links to other hospital departments when administering RBC transfusions. Sequential tasks were grouped into activity blocks with clear start- and end-points. A trained centre nurse measured the time devoted to each activity block with a stopwatch. The time devoted to isolated or less frequent activities was estimated from interviews. Unit costs for personnel time, supplies, laboratory tests, waste management and overhead costs were collected in each centre. RESULTS: Seven transfusions were observed in the French and eight in the Austrian setting. The average duration per transfusion, including all the observed and non-observed activities performed by the different health care professionals (physician, blood bank physician, nurse, auxiliary nurse, receptionist and lab technician) was 3hours 15min (min: 1h50; max: 4h50) in the Austrian setting and 4hours 31min (min: 2h35; max: 6h39) in the French setting. A different organisational structure in the blood transfusion centres explains the time difference observed. The average cost per transfusion was €361 (min: €315; max: €411) in Austria and €396 (min: €224; max: €452) in France. Personnel costs in Austria were higher than in France, but the official listed hospital price for 1 RBC blood pack in Austria was considerably lower (€115 versus €166). CONCLUSION: Time involved in one RBC transfusion among anaemic cancer patients may differ substantially between centres due to different organisational structures. Comparing the average cost per transfusion between countries may not reflect these differences when important unit cost variations between European countries exist.