OBJECTIVES: To assess the lifetime incremental cost-effectiveness ratios (ICER) per quality-adjusted life-year (QALY) gained and multinomial expected value of perfect information (mEVPI) of sequential follicular lymphoma (FL) treatment in Finland. METHODS: The novel cancer treatments included rituximab (R) and bendamustine (B). A probabilistic Markov-model was developed to simulate patients’ transitions between first-line progression-free (PF1), PF2, progression and death states using a second-order Monte Carlo-simulation, one month cycle, and half cycle correction. All patients received the recommended induction with R-cyclophosphamide-doxorubicin-vincristine-prednisone (RCHOP). For the RCHOP-induction responders, the sequence was continued without the first-line R-maintenance treatment (RCHOP) or with it (RCHOPR). PF1 was based on the best fitting parametric extrapolation (Gompertz; 4-year treatment benefit trunk) of PRIMA (Primary RItuximab and MAintenance) data. After RCHOPR or RCHOP, eligible patients were assigned to second-line RCOPR/B or RCOPR/COP based on the PRIMA results, B indication/labelling and the recent ESMO (European Society for Medical Oncology) guideline for FL. PF2s (5-year treatment benefit trunk) were based on the parametric estimate of EORTC20981 and adjustment based on Rummel’s trial. After PF2 (progression), patients received best supportive care (BSC). Age-dependent death was set equal to the larger of EORTC20981 or Finnish background mortality. Payer costs were included in 2010 value, and the most affordable public drug costs (2/2011; wastage included) were used. EQ-5D-based utilities were set 0.78 for PF1/PF2 and 0.62 for progression. 3% annual discounting was used. RESULTS: The ICERs for RCHOPR->RCOPR/B->BSC, RCHOPR->RCOPR/COP->BSC and RCHOP->RCOPR/B->BSC were €9575, €9881 and €8812 per QALY gained in comparison to RCHOP->RCOPR/COP->BSC, respectively. According to the cost-effectiveness acceptability frontier, 47% of patients with RCHOP->RCOPR/COP->BSC, 46% and 68% of patients with RCHOPR->RCOPR/B->BSC were cost effective at the ICER-levels of €5,000 (mEVPI €5,047/patient), €15,000 (mEVPI €3,101/patient) and €25,000 (mEVPI €1,564/patient) per QALY gained, respectively. CONCLUSIONS: First-line R-maintenance is an efficient and potentially cost-effective start for FL-treatment sequence.