OBJECTIVES: New treatment options for advanced non-squamous NSCLC offer improved survival over standard chemotherapy but must also offer value for money. Bevacizumab, a humanised monoclonal antibody against VEGF, plus chemotherapy increases overall survival and progression-free-survival (PFS) in advanced NSCLC patients versus chemotherapy alone. Pemetrexed, a thymidylate synthase inhibitor, has shown non-inferiority over cisplatin plus gemcitabine. This study evaluated the cost-effectiveness of BCG compared with iPC in Germany.  METHODS:   A Markov model evaluated the average costs and benefits of treating advanced or recurrent NSCLC patients with BCG or PC.  The patient characteristics of an average German hospital patient were applied.  The model assumes patients move from pre-progressive to progressed disease to death, according to a set of transition probabilities derived from the respective pivotal trials and appropriate indirect comparison methodology. Drug costs assume underlying chemotherapy is given for up to 6 cycles, but that bevacizumab is administered until progression or unacceptable toxicity. The model estimates average survival, PFS, drug, administration and progression costs per patient treated with BCG or PC and the incremental cost-effectiveness ratio.  RESULTS:   BCG gave mean survival of 1.51 versus 1.31 years with PC and mean PFS of 0.75 versus 0.54 years, respectively. The mean total monthly treatment costs for the base case analysis were €5870 versus €6637, respectively (savings of €767 for BCG per patient). Monthly drug costs alone were €5497 for BCG compared with €6161 with PC. CONCLUSIONS:   BCG triplet-therapy offers greater clinical benefits than PC doublet-therapy at a lower overall cost, suggesting that BCG is dominating PC in treating patients with advanced NSCLC in Germany.  The overall cost of BCG is likely to further reduce following the recent gemcitabine patent expiry, providing potential further cost savings of BCG to the German health care system.