OBJECTIVES: To assess the efficiency of the atypical antipsychotics used to reduce relapses in bipolar disorder, taking into account costs and effectiveness (measured as QALY). METHODS: The Russian health care system perspective and a 5 year temporal horizon have been used. An annual discount rate assumed was of 5%. Taking into account the last literature review on bipolar disorder, four fundamental aspects related with bipolar disorder management were analyzed: relapse rates, inpatient treatment, outpatient treatment and hospitalization rates. The health care direct costs corresponding to the drug acquisition costs have been analyzed together with the costs of inpatient diagnostics, costs of inpatient treatment and costs of hospitality relapses (stay and drug cost) updated with data from Russian health care system. RESULTS: Quetiapine or risperidone treatment presents the lower total costs (€13,562 and €13,097 respectively) compared with the other strategies (aripiprazole = €36,328 and olanzapine = €19,957). Quetiapine presents the higher efficacy (QALY) compared with the alternatives (quetiapine = 3.551, risperidone = 3.534, aripiprazole = 3.528 and olanzapine = 3.525). With these results one can emphasize that quetiapine or risperidone treatment is dominant with the cost-effectiveness ratio (CER) of 3819 and 3706, respectively, versus aripiprazole or olanzapine groups (CER 10,297 and 5,662 respectively). The incremental CER (quetiapine vs. risperidone) is €27,322 per QALY. CONCLUSIONS: The results of cost-effectiveness illustrate that quetiapine is dominant compared with aripiprazole or olanzapine. Also quetiapine therapy is within willingness to pay threshold in case of risperidone substitution in Russian patients with bipolar disorder who are initiating atypical antipsychotics therapy.