OBJECTIVES:  Low dose 7-day buprenorphine transdermal patch (norspan®) is an opioid analgesic indicated in the management of chronic moderate to severe pain not responding to non-opioid analgesics. This patch has been marketed as products not covered by the national health insurance. The purpose of this analysis was to evaluate cost-effectiveness and budget impact of the buprenorphine patch, thereby assessing its eligibility for National Health Insurance coverage. METHODS:   We carried out a cost-effectiveness analysis of the buprenorphine patches compared to tramadol tablets in patients with chronic, moderate to severe osteoarthritis (OA) pain, using a third-party-payers perspective. The time horizon of analysis was 12-week. During this period, it was assumed that doses of study medication were titrated twice to achieve stable pain control. Patients’ global impression of pain relief was used as a clinical outcome variable, based on which we defined good and very good pain relief as controlled pain. Expert survey was conducted to investigate the treatment pattern and the cost of chronic pain. Budget impact analysis was applied to assess the impact of insurance coverage of buprenorphine patches. Sensitivity analysis was performed for major parameters and possible scenarios. RESULTS: Buprenorphine patch was dominant compared to its comparator, displaying increased effectiveness and reduced costs. Budget impact analysis for 5 years indicated drug costs might increase by nearly 12.2 billion won upon application of buprenorphine patch for insurance coverage; however, the budget for National Health Insurance including medical cost might decrease by nearly 2.9 billion won mainly due to decrement dispensing fee. Sensitive analysis suggested that the most sensitive variable was the effectiveness of buprenorphine patches.  CONCLUSIONS: Low dose 7-day buprenorphine patch was a cost-effective and cost-saving alternative in the Korea National Health Insurance context. Study robustness needed more evidences about effectiveness.