OBJECTIVES: To evaluate the treatment management cost, over 12 weeks, of asenapine relative to quetiapine, olanzapine, and aripiprazole which are currently used in Finland and Sweden to treat moderate to severe manic in bipolar I disorder. METHODS: A cost-minimisation analysis was conducted from a Finnish and Swedish societal perspective. Costs were the only consideration due to similar clinical efficacy of asenapine demonstrated in active controlled non-inferiority clinical trial vs olanzapine and through indirect comparisons with quetiapine and aripiprazole. Due to significant differences in adverse events and healthcare system costs, we included management of weight gain, akathesia and insomnia. Patients were assumed to start treatment as an inpatient for the first month of therapy, and then followed for two months in an outpatient setting. All direct and indirect resource use and unit cost estimates were derived from the latest available sources and literature. No evidence exists suggesting any differences with respect to healthcare management (e.g. hospitalisation) between treatment strategies. Thus, estimated resource use and costs applied were assumed the same across treatment strategies. Deterministic sensitivity analyses were conducted to explore uncertainty around input parameters. RESULTS: The estimated direct cost of treatment and of the management of adverse events related to treating adults with bipolar I disorder suffering a manic or mixed episode for 12 weeks with asenapine monotherapy for Finland and Sweden were respectively: €421 and €670 (SEK 6,044) compared to €502 and €1139 (SEK 10,257; aripiprazole), €141 and €827 (SEK 7,453; quetiapine), and €344 and €957 (SEK 8,616; olanzapine). CONCLUSIONS: Asenapine has been shown to be cost saving relative to aripiprazole in Finland and to quetiapine, olanzapine, and aripiprazole in Sweden at the short-term endpoint of 12 weeks. The estimated treatment cost represented less than 6% of the overall burden of bipolar disorder from societal perspective.