A phase III clinical trial demonstrated the advantage of denosumab over zoledronic acid(ZA) in delaying the first on-study and subsequent skeletal-related events(SREs) in patients with prostate cancer(PC). Recently, generic ZA became available. The purpose of this study was to examine the cost-effectiveness of denosumab vs. brand or generic ZA in the prevention of SREs in Kazakhstani patients with PC.