OBJECTIVES: The purpose of the study was to assess the cost-effectiveness of the recombinant human PTH(1-34) (teriparatide) (Forsteo, Eli Lilly) and recombinant human PTH(1-84) (Preotact, Nycomed) in subjects with similar clinical characteristics to patients with osteoporosis in normal Swedish clinical practice. METHODS: The cost-effectiveness was estimated in an existing Markov cohort osteoporosis model using 6-month cycles and a lifetime horizon. The model was populated with Swedish epidemiological and economic data. To reflect the normal clinical practice, the simulated subjects corresponded to the Swedish cohort in the European Forsteo Observational Study (EFOS) (mean age 72 years, total hip T-score -2.7, 3.5 prevalent vertebral fractures). The cost per QALY gained of both teriparatide and PTH(1-84) was estimated compared to no treatment based on efficacy estimates from phase III pivotal clinical trials of each drug. For teriparatide, the risk reduction for new vertebral fractures was 65% and for non-vertebral fragility fractures 53%, while PTH(1-84) reduced the risk of vertebral fractures by 58% and showed no difference in non-vertebral fracture risk reduction. An indirect cost-effectiveness comparison between the two regimens was also attempted. The annual drug cost of teriparatide and PTH(1-84) in Sweden was €5241 and €4643, respectively. Both treatment regimens were assumed to be given for 18 months per local reimbursement guidelines. The analysis took a societal perspective excluding costs in added life years in the base estimations. RESULTS: In the base case analysis excluding the impact of hypercalcaemia the cost per QALY gained with teriparatide and PTH(1-84) vs. no treatment was estimated at €47,811 and €125,474, respectively. An indirect comparison between the two treatments indicated teriparatide to be a dominating alternative. CONCLUSION: This study suggests that, based on the efficacy estimates from pivotal clinical trials and the Swedish cost of both drugs, teriparatide is a more cost-effective treatment option than PTH(1-84).