OBJECTIVES: Oral glucosamine formulations are frequently used as a food supplement for joint maintenance, with little supportive evidence. However, Glusartel, a formulation of glucosamine (produced by Rottapharm), has been shown to increase oral bioavailability and has been studied in over 7,000 patients, showing a significant improvement in joint space narrowing and knee replacement. The cost-effectiveness of the new product was studied compared to both standard of care and other glucosamine products. METHODS: A four state (with death as a sink state) Markov model was constructed to investigate disease progression, patient utility (mapped from the Western Ontario and McMaster Universities Arthritis Index (WOMAC)) and cost. Efficacy was taken from two pivotal trials, while costs were taken from standard sources including NHS Reference Costs, PSSRU, and the British National Formulary. All costs were inflated to financial year 2009/2010, with the perspective taken that of NHS Scotland. RESULTS: Using a 50 year (lifetime) time horizon, with patients beginning treatment at age 62 (as seen in the clinical trials), patients treated with Glusartel are estimated to cost £1799 more than those treated with standard management (£6443 vs. £4645), but gain an additional 0.15 (2 d.p.) QALYs (9.45 vs. 9.31), generating an ICER of £12,402. Compared with currently used glucosamine treatment, even conservatively assuming equal efficacy, Glusartel produces a cost saving of £700, and is dominant in outcomes when the assumption around treatment efficacy is relaxed. The model is sensitive to the time horizon, utility in mild/moderate arthritis and data source for costs, with the main driver being the efficacy of Glusartel in delaying severe arthritis. CONCLUSIONS: From the perspective of NHS Scotland Glusartel is highly cost-effective compared to standard of care, and cost saving compared to other glucosamine products. By revising existing prescribing patterns, NHS Scotland could both improve patient outcomes, and realise cost savings.