OBJECTIVES: Recombinant human bone morphogenetic protein (rhBMP2) is a growth factor for new bone formation. The objective was to calculate cost savings for the use of rhBMP-2 in grade III open tibia fractures for Germany, France and UK from a public health care system and a societal perspective, respectively. METHODS: A health economic model was developed based on clinical data from a previously published randomized controlled trial (BESTT study) comparing rhBMP-2 + standard of care (soft tissue management and intramedullary nailing) with standard of care alone. Clinical data were transferred using reimbursement 2005 tariffs (German-DRG, UK-NHS, French-Social Security tariffs) and published data for sickness payments and productivity loss for a one year time horizon. RESULTS: In Germany and France sickness payments are provided by public health care insurances and therefore, the payer perspective is identical to the societal perspective. In Germany, the use of rhBMP-2 for grade III open tibia fractures savings of direct costs of 1359 € per patient and of 2714 € for sickness payment resulting in total savings of 4073 € per patient that offset the price of rhBMP2 (2950 €). For France, there are total savings of 3476 € with savings in direct costs of 1197 € and in indirect costs of 2279 € which outbalance the price of rhBMP-2. For UK, rhBMP-2 achieves savings of £1126 from a payer perspective which is below price of rhBMP-2 (£1790). However, from a UK societal perspective total savings of £5139 make rhBMP-2 a cost saving strategy. For all three different countries the major driver for cost savings is the faster fracture healing with reduced expenses for sickness leave payments and productivity gain, respectively. CONCLUSION: rhBMP-2 is a cost saving strategy in grade III open tibia fractures from a payer perspective for Germany and France and from a societal perspective for UK.