Background: Prostate cancer is the leading neoplasm among men worldwide. The objective of this study is to evaluate the cost-effectiveness of the addition of chemotherapy or abiraterone to ADT after a network meta-analysis and an indirect comparison between chemotherapy and abiraterone. Methods: We made a literature review and included studies that evaluated the addition of docetaxel or abiraterone to ADT versus ADT alone for patients with castration-sensitive metastatic prostate cancer. Studies’ outcomes were modeled on a logarithmic scale using the Bayesian hierarchical model for indirect comparisons between interventions. Then, we developed an analytical model to determine the cost-effectiveness of the addition of docetaxel or abiraterone versus ADT alone. Direct and indirect costs were included in the model considering Brazilian costs. Results: Four clinical trials were included in the network meta-analysis. Evidence suggests that the addition of abiraterone to ADT is the best therapeutic option in terms of OS ( > 95% probability; HR 0,81; 95% CrI 0,66 – 1,00) and FFS ( > 99% probability; HR 0,50; 95% CrI 0,40 – 0,62) compared to ADT plus docetaxel. Abiraterone plus ADT had fewer cases of febrile neutropenia than docetaxel plus ADT (1% versus 15%). Compared to ADT alone, the addition of chemotherapy generated 0.492 QALY and the addition of abiraterone generated 0.999 QALY. Abiraterone led to a QALY gain of 0.506 compared to docetaxel. In Brazil, the incremental costs per QALY were $40,500, $100,251 and $173,145, respectively. At current costs, docetaxel plus ADT is more cost-effective than abiraterone plus ADT. The factors that had the greatest influence on cost-effectiveness were the overall survival and failure-free survival confidence intervals. Price discounts on abiraterone purchasing was the factor that led to the greatest impact on the incremental cost (ranging from $100,000 to $40,000). Conclusions: We conclude that the addition of chemotherapy to ADT is more cost-effective than the addition of abiraterone to ADT. However, discounts on abiraterone cost might improve cost-effectiveness.