OBJECTIVES: The purpose of this study was to assess the cost-effectiveness of drospirenone 2mg/estradiol 1.033 mg (DRSP/E2) versus tibolone 2.5mg in the treatment of postmenopausal women with Grade 1 or 2 hypertension in Korea. METHODS: A lifetime Markov model was developed for a population of postmenopausal women indicated for hormone replacement therapy (HRT) who had Grade 1 or 2 hypertension. Patients initially started on two years of HRT and progressed through the model according to their BP status and added on AHT medication as required. Patients experienced MI or stroke as determined by their BP status, which is a major risk factor for CVD. Continuation rates for HRT and antihypertensive therapy (AHT), CVD risk and utilities were obtained from published articles. Unit cost, resource use and treatment practice for AHT were based on physician interviews. Only direct medical costs were included. A discount rate of 5% was used for both costs and outcomes according to HIRA guidelines. The model reported effectiveness outcomes in quality-adjusted life years (QALYs) with a 59% premium price for DRSP/E2 over tibolone. RESULTS: DRSP/E2 was cost-effective compared to tibolone. The base case had an  incremental cost-effectiveness ratio (ICER) of 11,105,517 KRW per QALY gained. Probabilistic sensitivity analysis showed 80.4% probability the ICER would fall below the threshold of 20 million KRW. BP lowering qualities of DRSP/E2 provide additional benefits of decreased need for AHT medication and decreased risk of myocardial infarction (MI) and stroke for postmenopausal women with Grade 1 or 2 hypertension. CONCLUSIONS: In Korea, DRSP/E2 proved cost-effectiveness compared to tibolone offering additional benefit of aiding BP control compared to standard HRT.