OBJECTIVES: To estimate cost-effectiveness of rFVIIa compared to standard care in treating ICH over an average MCO enrollment period of two years from a third-party payer perspective. METHODS: A decision-analytic model estimating cost-effectiveness of rFVIIa 80mcg/kg compared to standard care in treating ICH was adapted to measure cost-effectiveness over a time horizon (enrollment period) of two years. Input parameters were obtained from clinical trial, claims data, and published literature. Cost of rFVIIa was based on wholesale acquisition cost. Costs were in 2006 US dollars. Outcomes included life-years and quality-adjusted life years (QALY). In addition, population characteristics were considered, including age (over/under 65) and gender comparisons. One-way and multivariable sensitivity analyses were conducted to assess robustness. RESULTS: Assuming a cost-effectiveness threshold of $50,000 QALY, the incremental cost-effectiveness ratio (ICER) showed rFVIIa to be cost-effective compared to standard care alone ($2,924/QALY gained). Use of rFVIIa was found to be cost-effective in both the under- and over-65 populations ($532/QALY gained and $5,323/QALY gained, respectively). Results did not differ substantially across gender. Results were robust to changes in model parameters. CONCLUSION: Treating ICH with rFVIIa 80mcg/kg within an MCO is cost-effective over the average patient enrollment period of two years compared to standard care. Due to potential improvements in long-term clinical outcome, treatment with rFVIIa may have an even greater positive impact in health plans with a younger population.