OBJECTIVES: Myelofibrosis (MF) is a rare and life-threatening myeloproliferative disorder characterized by progressive scarring of the bone marrow and a number of severely debilitating symptoms. The objective of this analysis was to estimate cost-effectiveness of ruxolitinib (RUX) in a treatment of MF patients compared with best available therapy (BAT) in Finland. METHODS: Efficacy data from RUX pivotal trial COMFORT-II was used as the most relevant clinical evidence of RUX versus BAT. A survival-based decision model with health states On-Treatment, Off-Treatment and Dead was constructed. Transitions between the health states were determined by overall survival (OS) and treatment discontinuation collected in COMFORT-II. Treatment discontinuation was used a proxy for progression. The model was calculated as a cohort expected value analysis with each health state having associated costs and utilities. Costs for health states included drug acquisition costs and health care resource use (HRU) classified by MF risk status (high or intermediate-2) and leukemia. HRU estimates are based on patient level data (n=88) from Auria Biobank, and utility values were based on a standard gamble study. Finnish health care payer perspective was employed. The time horizon in the base case was a lifetime with 3 % discounting for costs and outcomes. RESULTS: Treatment with RUX produced 2.43 incremental QALYs with the incremental cost of €102,802 compared to BAT, resulting incremental cost-effectiveness ratio 42,367€/QALY. Sensitivity analyses showed that the model was robust to changes in model inputs. The most impactful parameters were the disease management costs and the hazard ratio for OS. CONCLUSIONS: The results suggest that the improvements in OS provided by RUX translate into long term gains in QALYs with reasonable incremental costs. The use of robust real-life data from Auria Biobank is beneficial in managing uncertainty that relates to assumptions and data inputs of the model.