OBJECTIVES: To assess the burden of illness and costs associated with managing patients with bone pain secondary to metastatic prostate cancer, using 153Sm-lexidronam as palliative therapy. METHODS: Medical records of a convenience sample of 712 patients undergoing palliative treatment for metastatic prostate hormone-refractory adenocarcinoma (androgen-independent prostate cancer) at US VA facilities between March 2000 and December 2002 were reviewed. Of this population, 85 patients [11.9%] received 153Sm-lexidronam, 299 [42.1%] underwent external beam radiation therapy [EBRT], 167 [23.4%] received pamidronate disodium, 42 [6.6%] received mitoxantrone, and 119 [16.7%] were principally treated by opioid analgesics. Patients were treated to achieve optimum pain control. Resource utilization data were collected for 12 months commencing with initial referral for cancer pain management. Sociodemographic characteristics, laboratory values, and charge data scores were analyzed using descriptive statistics and unpaired Student's t-test in a cross-sectional study design. RESULTS: No statistically significant inter-group differences were observed in patient sociodemographic characteristics and PSA levels. During the 12-month observation interval considered for this analysis, opioid-based palliation was most costly with in-patient charges comprising the greatest portion of all charges, whereas EBRT was most costly according to out-patient charges. 153Sm-lexidronam-based management was least costly in terms of both in-patient and out-patient charges. CONCLUSION: The costs associated with the use of 153Sm-lexidronam, a radiopharmaceutical previously demonstrated as safe and effective in the management of patients with metastatic prostate cancer, are no higher, and generally less, than most other options. Therefore, 153Sm-lexidronam should be considered a low cost intervention when compared to other palliative management options in managing bone pain secondary to metastatic prostate cancer.