OBJECTIVES:  This study aims to evaluate cost effectiveness of currently available first-line TKIs, Dasatinib (100mg), Nilotinib (600 mg) and Imatinib (400mg), in treatment of newly diagnosed CML patients in Korea. METHODS:  We developed a Markov model model composed of four health states: response in chronic-phase (CP), no-response in CP, accelerated or blastic phase (AP/BP) and Death. Progression rate to AP/BP is assumed to be dependent on the presence of cytogenetic or molecular response to TKI at 12 month. Clinical effectiveness were obtained from systematic review and meta analysis. In terms of cost, only direct medical costs (e.g. outpatient, hospitalisation and medication costs) with 5% of patient copayment were included into the study. Average medical cost of CML patients were calculated using claims data from the National Health Insurance Service of Korea. All costs were measured in Korean won (KRW) and converted to US dollars (USD) using 2014 official exchange rate (1USD=1,053.22KRW). Discount rate of 5% was applied to cost and effectiveness.RESULTS:  Based on complete cytogenetic response rates at 12 month, Imatinib ($274,215) was less costly than Dasatinib ($385,147) and Nilotinib ($442,141). Life-year gains of Dasatinib (16.04 LYs), were superior to other TKIs (Imatinib: 15.34 LYs, Nilotinib: 15.99 LYs), but ICER was $156,635 per LYs which far exceeds current willingness to pay level ($28,959) in Korea. Applying major molecular response rates at 12 month, the most effective strategy was Nilotinib ($412,643, 15.59 LYs), but its cost was the highest among others: Dasatinib ($361,317, 15.27 LYs) and Imatinib ($259,184, 14.56 LYs). The ICER of Dasatinib and Nilotinib was $92,952 and $159,670 per LYs respectively compared to Imatinib.CONCLUSIONS:  Given the current willingness to pay level of $28,959 in Korean setting, Imatinib (400 mg) was found out to be the most cost-effective strategy compared to Dasatinib (100mg) and Nilotinib (600 mg).