OBJECTIVES: Glucocorticoid induced osteoporosis is the most common cause of secondary osteoporosis. The objective of this study was to estimate the cost-effectiveness of teriparatide in patients with Glucocorticoid induced osteoporosis in Sweden. METHODS: A cost-effectiveness analysis was developed to evaluate the direct medical and tertiary care costs and clinical outcomes of an 18-month regimen of daily teriparatide in patients with glucocorticoid induced osteoporosis (GIO). A Monte Carlo simulation was used to model the cost and effects of a simulated cohort of 100,000 patients with GIO treated with teriparatide compared to no teriparatide treatment. The model simulated the course of events in 6-month cycles in individual patients over a lifetime horizon. During each cycle the patients were at risk of experiencing clinical vertebral, hip and wrist fracture or death (either natural or excess mortality due to fracture). Swedish data on fracture costs, utility reductions after fracture, fracture risks and mortality rates were used. Uncertainty was investigated using one-way and probabilistic sensitivity analyses. Costs and utilities were discounted at annual discount rates of 3%. RESULTS: The analysed cohort comprised patients aged 69 years (80% female) with a BMD T-Score of -2.5 SD and an historical vertebral fracture (5 years previous) and an incident vertebral fracture. In the base-case analysis of this cohort the costs in the teriparatide treatment group were 558,918 SEK per patient compared to 552,026 SEK in the no teriparatide group. The cost per QALY gained of teriparatide compared to no teriparatide was estimated to be SEK 25,000. The results were robust under a wide range of assumptions. CONCLUSIONS: For the analysed cohorts, the base case and one-way sensitivity analyses performed indicate that an 18-month teriparatide regimen versus no treatment in patients with glucocorticoid induced osteoporosis is cost-effective from the perspective of the Swedish payer.