OBJECTIVES: Riociguat is the first product proven to improve health status in CTEPH patients. The objective of this study is to evaluate the cost-effectiveness of riociguat for patients with inoperable CTEPH or post-operative recurrent/persistent CTEPH in Turkey. METHODS: A Markov model taking transitions of patients between functional classes and death state as core was adapted to Turkish setting. Turkish payer’s perspective was taken and time-horizon was set as patient’s lifetime (maximum 30 years) broken into four-month cycles. Riociguat was compared to placebo and common off-label treatments within the model. Essential clinical inputs were derived from CHEST-1 and CHEST-2 trials and local resource-utilization data were conducted through an expert panel. The incremental cost-effectiveness ratios (ICER) were calculated per life-years (LYs) gained and sensitivity of the results was analyzed for all comparators and placebo in terms of key inputs.  All costs were calculated in Turkish Liras (TL) and converted to USD using TL/USD currency rate as 2.1 (mid-2014). RESULTS: Total cost of riociguat-treated patients is 1,558, 7,342 and 59,706 USD higher compared to bosentan, ambrisentan and sildenafil respectively and 74,227 USD lower compared to iloprost. Besides, riociguat is associated with increments of 1.0034, 1.0878, 1.8174 and 1.8872 LYs compared to bosentan, ambrisentan, iloprost, sildenafil and placebo respectively. The ICER of riociguat per LYs gained compared to bosentan, ambrisentan, sildenafil and placebo were determined as 1,553 USD, 6,750 USD, 31,638 USD and 39,553 USD correspondingly. Model is sensitive only to the changes in “the starting age of the disease”, yet not to an extent to affect the final results. CONCLUSIONS: Riociguat is cost-effective for CTEPH treatment compared to bosentan, ambrisentan, sildenafil and placebo with ICER values below the willingness-to-pay threshold (3-times GDP per capita ─ 32,346 USD) for Turkey. Furthermore, riociguat is pharmacoeconomically dominant to iloprost with lower costs and higher clinical effectiveness.