OBJECTIVES: To compare the resource use and related costs associated with the management of fibromyalgia (FM) in five European countries (UK, France, Italy, Spain, Germany). METHODS: The UK resource use data were extracted from medical records of 2,260 patients diagnosed with FM between 1998 and 2003 in the General Practice Research Database (GPRD). For the other countries, a questionnaire was created based on the UK data and local experts, GP and rheumatologists, were asked to compare their own clinical practice to UK prescriptions in terms of tests, drugs, general practitioners and specialists visits, over a period of -4 years before diagnosis to +4 years after the diagnosis. Information on paramedical and alternative care was also collected for France, Italy, Spain, Germany. Inpatient care and productivity loss were not included in GPRD and thus also not in the questionnaire. The public payer and societal perspective were used. RESULTS: Resource use and average costs related to lab tests per person-year from the public health care payer perspective were highest in Spain (10,1€) and the UK, the year of diagnosis and decrease afterwards (€69 in Spain). Drug costs are higher in Germany (€242€) mainly due to the higher unit costs. Costs related to GP visits increase till diagnosis in Germany (€892) and the UK. The costs for referrals to specialists are the highest before diagnosis in the UK (€131), France, and Italy. Overall, the highest mean annual total cost per patient from the societal perspective was found in Germany (€1,897), the lowest in Italy (€454). The highest patient contribution was seen in France (54%), the lowest in Italy (16%). CONCLUSIONS: Although moderate differences between countries were found in the management of FM, once a formal FM diagnosis was made, the resource use and costs decreased independent of the countries studied.