OBJECTIVES: Rituximab-containing chemo-immunotherapy is standard first-line induction treatment for patients with follicular lymphoma. After induction, patients may receive rituximab maintenance therapy or no further treatment. This study aimed to assess the cost-effectiveness of rituximab maintenance therapy compared with no treatment in patients with follicular lymphoma from an Australian healthcare provider perspective. METHODS: We constructed a Markov model-based probabilistic cost-effectiveness analysis and compared rituximab maintenance therapy with no treatment – in terms of lifetime costs, quality-adjusted life years, and cost-effectiveness. A systematic review was performed to identify all relevant randomised controlled trials and utility values for the economic model. Progression-free survival was based on the long-term published data of the PRIMA and EORTC 20981 trials for previously untreated and relapsed patients respectively. Costs were estimated using published data, and included costs of drug and administration, adverse events, treatment of relapses, and end-of-life care. A 5% discount rate was used for both costs and health outcomes.  RESULTS: At the listed price, if maintenance therapy is available the cost per quality-adjusted life year gained is $74,989. The economic model is most sensitive to the rituximab price; if the rituximab price is reduced by 25%, the cost per quality-adjusted life year gained will fall to $56,097. CONCLUSIONS: Rituximab maintenance compared with no maintenance treatment is cost-effective in Australia at a lower rituximab price. The sensitivity analyses provided enable decision makers in other countries with similar health care practices to Australia to determine the acceptability of cost-effectiveness ratios according to their willingness-to-pay thresholds.