OBJECTIVES: To evaluate cost implications of oral chemotherapy with capecitabine vs. standard fluoropyrimidine-therapies (Mayo Clinic and AIO/Ardalan-regimen), in different treatment settings in Germany. METHODS: Costs of fluoropyrimidine-therapies were evaluated for the office-based setting. Physician's fees (89 quarterly fee-listings, 26 patients, 6 office-based oncologists), drug and pharmacy costs and costs for venous port systems and single-use pumps were included. Capecitabine treatment costs were assumed to be identical to the cost of the Mayo Clinic-regimen, except drug administration and acquisition. Based on the frequency of administration of active drugs by office-based oncologists costs were modelled for 4 scenarios in the hospital sector, i.e. in- and outpatient treatment in university- and municipal hospitals. A third-party payer perspective was adopted. Market research data on frequency and setting of use of the evaluated regimens were used to estimate potential overall cost implications. RESULTS: Treatment costs for a 6-months course in the office-based setting was most expensive with the AIO/Ardalan regimen (€ 20,358) and cheapest with capecitabine (€ 4,776). In contrast, the AIO/Ardalan-protocol was cheaper than the Mayo Clinic-protocol in all hospital settings (AIO/Ardalan € 2,588 - 13,434; Mayo Clinic 4,072 - 21,138). Potential direct yearly savings by switching patients from Mayo-Clinic- or AIO/Ardalan-regimen to oral capecitabine were estimated at € 78-84 Mio. CONCLUSION: The most expensive treatment options were the AIO/Ardalan-protocol in the office-based setting and the Mayo Clinic protocol in the hospital setting. Interestingly, remuneration for hospitals is unlikely to be cost covering for some treatment situations, in particular with the AIO/Ardalan-regimen. Capecitabine emerged as the cheapest option in the office-based setting (NA for hospital due to oral administration). Transferring patients to oral capecitabine is likely to result in substantial cost savings, estimated at €78-84 Mio annually. Savings are likely to be substantially higher if combination therapies with irinotecan or oxaliplatin are considered.