OBJECTIVES: To explore the cost-effectiveness of quetiapine, aripiprazole or olanzapine in Russian Federation (RF) patients with bipolar disorder (BPD) depression episodes. METHODS: A cost-effectiveness analysis (CEA) was developed to estimate the cost-effectiveness of quetiapine compared with aripiprazole or olanzapine. CEA was undertaken from RF health care perspective using discount rate of 5%. The time horizon of the analysis was ne year for using preventive relapse rates and five years for QALY. Direct health care expenses associated with bipolar disorder and resulting follow-up costs were calculated using general tariff agreement of Russian obligatory insurance system and official national statistics.  For reference, accepted exchange rate was 1 EUR = 40 RUB. RESULTS: Taking into account rates of prevented relapse following cost-effectiveness ratios (CER) were obtained: 156,915 RUB (3,923 EUR) in quetiapine group, 429,362 RUB (10,734 EUR) in aripiprazole group and 221,879 RUB (5,547 EUR) in olanzapine group. Using QALY values CER were accounted for: 185,236 RUB (4,631 EUR) in quetiapine group, 478,433 RUB (11,961 EUR) in aripiprazole group and 254,100 RUB (6,353 EUR) in olanzapine group. CONCLUSIONS: Quetiapine in the treatment of BPD depression episodes is a dominant compared with aripiprazole or olanzapine.