OBJECTIVES: Hypertension is a chronic cardiovascular disease (CVD). Although there are numerous antihypertensive agents currently available, there is still an unmet need in the treatment of hypertension. Accordingly an expectation to a novel treatment for hypertension has been growing. It is aliskiren that is the first in a new class of orally effective direct rennin inhibitor for hypertension. Here, we investigate the cost-effectiveness of aliskiren in hypertensive patients in Korea. METHODS: The economic costs and clinical outcomes besides blood pressure(BP) lowering effect, between aliskiren 150mg and valsartan 160mg were measured and valued. Aliskiren has forgiveness factor (longer BP controlling effect without taking aliskiren compared to other anti-hypertensives) so that BP lowering and forgiveness factor were applied to CUA. Both costs and effectiveness were discounted by five percent. Sensitivity analysis was conducted on the discounting rate and on the baseline information of Cohort. RESULTS: In cost-utility analysis (CUA), providing that hypertensive patients were treated with aliskiren or valsartan for 30 year, the costs were 15,780 and 16,780 thousand KRW, respectively. Regarding life expectancy without discount rate, aliskiren and valsartan demonstrated 21.955(0.699), 21.944(0.692) respectively.However, there were interesting results in CUA. Quality-adjusted life year(QALY) of aliskiren and valsartan for 30 years were 9.791(0.240) and 9.786(0.239), respectively and the costs of aliskiren were estimated lower, which indicates aliskiren is dominant. Same results were reported regardless of conducting discount to life expectancy. In analysis of years free of coronary heart disease (CHD) and stroke, aliskiren was dominant compared to valsartan. Sensitivity analysis was consistent with cohort and changes in discounting rate.CONCLUSIONS: We conclude that aliskiren for hypertension treatment will provide cost savings in addition to clinical outcomes, not only BP lowering effect, but also organ protection, 24-hour BP control and forgiveness