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Objectives To assess the cost-effectiveness of methoxy polyethylene glycol-epoetin β (CERA) used in routine clinical practice for maintenance of Hb levels in patients with chronic kidney disease in predialysis and previous stabilised treatment with conventional epoetin. As secondary objective, we analyse the use of CERA in clinical practice. Methods Retrospective observational study including all patients receiving conventional epoetin who were switched to CERA over a period of 2 years. Demographic, clinical and therapeutic variables were collected. The main effectiveness outcome chosen was the difference between the haemoglobin level with conventional epoetin versus CERA after 24 weeks of treatment. Economic analysis was performed taking into account only the direct drug acquisition cost, the main cost outcome was the difference of patient/month cost with conventional epoetin versus CERA. Results Sixty-nine patients with a mean age of 68 years (35% male) were enrolled in the study. In 92.8% of cases, the starting dose used was lower than that recommended in the summary of product characteristics. Mean haemoglobin at 0 and 24 weeks was 11.9 and 11.7 g/dL, with no statistically significant difference (−0.2, 95% CI −0.6 to 0.1). With CERA, a lower proportion of patients exceeded the haemoglobin limit of 13 g/dL. The patient/month cost was 159.6€ and 169.9€ at weeks 0 and 24, with a difference of 10.3€ (95% CI −6.8 to 27.5). Conclusions CERA was as effective as conventional epoetin for the maintenance of haemoglobin levels after 24 weeks of follow-up. Conversion to CERA has led to an increase of 10.3€ the patient/month cost.