Chemotherapy-induced nausea and vomiting (CINV) is one of the side effects that can reduce the quality of life. A 5-HT3 receptor antagonist like ondansetron, corticosteroid like dexamrthason, H2 blocker like ranitidine has been combinated to control moderately emetogenic chemotherapy induce-nausea and vomiting. Difference in combinations drug costs appear significantly. Cost effectiveness analisys (CEA) were conduct to measure and compare the effectiveness and cost of the treatment. A observasional study was done using total sampling method from retrospective data. Primary and secondary data collected from medical records, hospital information systems, and interviews. Female patients with breast cancer who were prescribed moderately emetogenic chemotherapy for the first time ini 2017-1019 were included in this research. The number of samples were 74 patients, which included 35 patients with drug combinations Ondansetron+Dexamethason+ Ranitidin, 15 patients with drug combinations Ondansetron+Dexamethason, and 14 patients with drug combinations Ondansetron+Ranitidin. The effectiveness is measured by the proportion of patients free of acute nausea and vomiting. The cost is average of direct cost, average of direct non-medical cost, average of indirect cost. Based on the result of this study, the effectiveness of drug combinations O+D+R (0,400) is greater than drug combinations O+D (0,267) and drug combinations O+R (0,214). The final result showed that combinations O+D+R (ICER: Rp 13.042.606) is more effective. Change of medication from combinations O+D to combinations O+D+R require extra cost Rp 13.042.606 for controlling acute nausea and vomiting due to moderately emetogenic chemotherapy.