The cost-benefit ratio in the treatment of aplastic anaemia with antilymphocyte globulin (ALG) combined with high-dose methylprednisolone (HDMP) was retrospectively compared with supportive palliative treatment alone. Over a 4-year period financial cost, response rate, survival and performance status was documented in 26 consecutive patients receiving this regimen. Outcome was favourable in 69% (group 1; N = 18) and in 13 comprehensive expenditure data were available. In the remainder (group 2; N = 8) treatment failed and they were considered to be the equivalent of a no-treatment population. Here hospital charges were analysed both with and without inclusion of ALG and HDMP. Over the 1-year study period, no significant difference in the median expenditure was found between group 1 at R19 281 (range R35 657-13 379) and group 2 at R18 522 (range R22 449-16 951). The median number of admissions for group 1 was one and for group 2 three, requiring a median of 19 and 20 days of hospitalisation respectively. At the end of the 1-year study period 19 of 26 patients were alive (73%), 69% having responded. At this time, 16 of the 18 patients in group 1 had returned to their previous occupations, but this had not been possible for any of the 8 in group 2. In suitably selected patients who do not have an allogenic bone marrow transplant option the expenditure on ALG and HDMP is both medically and economically sound and the combination can be recommended as a valuable treatment option.