Objective: The objective of the study is to evaluate cost-effectiveness of two sequential treatments; with Fulvetsrant sequence and without Fulvestrant sequence in the treatment of postmenopausal women with hormone receptor-positive local advanced or recurrent metastatic breast cancer in Korea. Methods: We developed a Markov model which allows assessments of the two sequential treatments to simulate the course of patients following each treatment pathway, estimating health outcomes through a long-term observation. The model was constructed with data from the literature and expert opinions. Markov health states was consisted of stable/responding, progressive, and death. The Markov cycle length is 28 days for each treatment and the cohort size is 1000 patients for each cohort. This study was analyzed from a societal perspective. All cost and outcomes were discounted at 5% and currency rate was applied to U.S. dollars. One-way sensitivity analysis and probabilistic sensitivity analysis were conducted. Results: The base case results that Cohort A (with Fulvestrant) had 1.037 QALY and Cohort B (without Fulvestrant) did 0.822 QALY at year 10. The expected costs results Cohort A spent $2704 more per patient; Cohort A $16,265 and Cohort B $13,562, respectively. The resulting ICER Per QALY was $9513 for cohort A to obtain a quality adjusted life year with respect to Cohort B in the 10- year model. The results of one-way sensitivity analysis showed stable; however; that of probability sensitivity analysis resulted from $15,796 to $16,863 with a range of QALY per person at 0.6964~0.8704 within 95% CI. Conclusion: Ten–year model of Cohort A in the treatment of postmenopausal women with hormone receptor-positive local advanced or recurrent metastatic breast cancer showed better clinical outcomes than Cohort B.