OBJECTIVES: Recombinant human bone morphogenetic protein (rhBMP2) is a novel biologic therapy that promotes bone growth at the fracture site. We compared the cost and cost-effectiveness of rhBMP-2 in open tibia fractures in Germany, France and UK. METHODS: We developed an economic model to compare rhBMP-2 + standard of care (soft tissue management and intramedullary nailing) with standard of care alone. Clinical data was obtained from the BMP-2 Evaluation for Surgery in Tibial Trauma (BESTT) trial and cost data from the national tariffs (German-DRG, UK-NHS, French-Social Security tariffs), reported in 2005 values. Utility weights were assigned to different grades (Gustillo I–IIIB) of open tibia fractures and differences in treatment outcomes were calculated. We performed the analysis from payer's/health care system's perspective for a one year time-horizon. RESULTS: In Germany, use of rhBMP-2 for grade III open tibia fractures resulted in cost-savings of €4073 per patient that offsets the upfront cost of rhBMP2 (€2950), representing net savings of €1123 per patient. Using rhBMP-2 in all grades of tibia fracture resulted in an incremental cost of €134 per patient and a cost-effectiveness ratio of €3052/QALY. In France, using rhBMP-2 for grade III open tibia fractures, and all fractures resulted in cost savings of €2312, and €824 per patient, respectively. When analyzed from the NHS perspective in the UK, rhBMP-2 treatment for grade III open tibia fractures resulted in a cost-effectiveness ratio of €10,847 (GBP7,445) per QALY and €32,151 (GBP22,066) per QALY for all types of fractures. CONCLUSION: From a payer's perspective, rhBMP-2 is a cost-saving treatment option in grade III open tibia fractures for the German and French health care systems and cost-effective for all grades of open tibia fractures in Germany, UK, and France.