OBJECTIVES: Recombinant human bone morphogenetic protein (rhBMP2) is a novel biologic therapy that promotes bone growth at the fracture site. We analyzed the cost-effectiveness of rhBMP-2 in open tibia fractures in Sweden and Denmark. METHODS: We developed an economic model to compare rhBMP-2 + standard of care (soft tissue management and intramedullary nailing) with standard of care alone. We obtained clinical data from the BMP-2 Evaluation for Surgery in Tibial Trauma (BESTT) trial and estimated treatment costs from national sources such as NORD-DRG for Sweden and DkDRG for Denmark. Total cost were measured as direct cost plus indirect costs and reported separately. Direct costs were measured as drug costs plus cost for complications and indirect costs were valued as lost productivity using average annual salaries. We assigned utility weights to different grades (Gustillo I–IIIB) of open tibia fractures to estimate the difference in quality-adjusted-life-expectancy. We performed the analysis from the healthcare payer's and societal perspectives for a one-year time-horizon. We focus our analysis on Gustillo grade III (A and B) fractures where rhBMP-2 is most commonly used. RESULTS: In Sweden, use of rhBMP-2 (€2,800) for grade III open tibia fractures resulted in an incremental cost of €1,684 per patient and in incremental cost-effectiveness ratio (ICER) of €22,811/QALY. When indirect costs were included, rhBMP-2 was cost-saving. In Denmark, rhBMP-2 (€3,100) treatment for grade III open tibia fractures resulted in an incremental cost of €1,635 per patient and an ICER of €17,964/QALY and was cost-saving when productivity loss was also included. CONCLUSION: From a payer's perspective, rhBMP-2 is a cost-effective treatment option in grade III open tibia fractures for both the Swedish and Danish healthcare systems. rhBMP-2 was a cost-saving option from the societal perspective, and therefore, a good value for money.