OBJECTIVES: Rituximab maintenance therapy (RM) has been shown to significantly extend overall survival (OS) and progression free survival (PFS) in relapsed/refractory follicular lymphoma (FL) in the pivotal trial EORTC20981. The purpose of this study was to assess, from the French Sickness Funds perspective, cost-effectiveness and cost-utility of RM after induction therapy versus current standard practice (observation). METHODS: A 3 health state lifetime transition model (30 years) was developed comparing RM and observation (Obs). PFS and OS were derived from the trial EORTC20981 with a median follow-up of 28 months and extrapolated from 2-year Kaplan-Meier curves using a Weibull distribution and were conservatively assumed to last only 5 years. Utility data were derived from a multicentric observational study using the EQ-5D questionnaire. Direct medical costs derived from French official sources. Costs were discounted at 3% and sensitivity analyses were performed. RESULTS: RM is effective in the management of relapsed/resistant FL. The results showed that life expectancy and QALY were increased respectively by 22% and 30% in patients treated with RM. Incremental cost-effectiveness ratio (ICER) was €7612 per life year gained. The cost per QALY gained was €8729. In one-way sensitivity analysis most of ratios fell within the range of €7,000 to €12,000 (the ICERs ranged from €5,700 to €43,300 per LYG and from 6,800€ to €49,700 per QALY). The frequency and cost of treatments upon relapse were identified as drivers for the model. Palliative care, transportation and indirect costs such as productivity loss were not included in the analysis. It was a conservative approach because it was expected that patients under RM would have less relapse and better life expectancy than those in observation. CONCLUSION: RM is a cost-effective strategy in the management of relapsed/refractory FL in France with an ICER largely below the threshold commonly cited in such analysis.