OBJECTIVES: The objective of this study was to determine the cost-effectiveness of tacrolimus ointment used twice weekly as a maintenance treatment regimen compared to a standard treatment regimen using tacrolimus twice daily in both adults and children with moderate to severe atopic dermatitis (AD) in Norway and Finland. METHODS: A decision analytic approach was used to compare costs and outcomes of two alternative management strategies for AD over a 12 month treatment period for the UK, which was adapted for Norway and Finland. Efficacy data were used from two randomised controlled trials where maintenance use of tacrolimus ointment (0.1% in adults and 0.03% in children applied twice weekly) was applied to previously affected areas compared to standard use (twice daily application) to treat disease exacerbations. Utility data were derived from a published source and cost data were taken from public list prices and tariffs in the two countries, Norway and Finland to generate cost/QALY.  Sensitivity analyses were performed to test the degree of uncertainty around the results. RESULTS: The twice weekly maintenance use of tacrolimus ointment resulted in fewer days in disease flare and improved quality of life versus standard treatment with tacrolimus ointment in both adults and children with moderate to severe AD. The twice weekly regimen was cost-saving compared with the standard regimen in both Norway and Finland. Sensitivity analyses demonstrated that results were largely insensitive to change. CONCLUSIONS: Twice weekly maintenance treatment of moderate and severe AD in both adults and children using tacrolimus ointment improves health outcomes at a lower cost when compared with the reactive treatment strategy using tacrolimus ointment.