OBJECTIVES: The budget impact of treating patients with severe chronic cancer and non-cancer pain with OROS®hydromorphone once-daily was determined in the German health care system. METHODS: An existing Excel® based hypothetical budget impact model (Fleischmann et al. 2008) calculating the cost consequences of using strong opioids (WHO step III) was updated using new market data (2009) and current prices (2010 public prices). The model has a one year time horizon adopting the perspective of the social health insurance accounting for costs of opioids, breakthrough pain and adverse events. Patient numbers are calculated using data from literature; adverse event rates are based on literature findings. Comparators included sustained-release morphine (twice-daily), controlled-release oxycodone (twice-daily), hydromorphone (twice-daily), transdermal fentanyl and transdermal buprenorphine. Initial prescription share of OROS® hydromorphone was 3.7% (2009). This share was hypothetically extended to 5%. It was assumed that this increase in prescription is gained by switching patients from their previous oral medication to OROS® hydromorphone. Titration and maintenance dosing schemes taken from previous analyses are used to model the switch. Morphine equivalences  were chosen according to SmPC. RESULTS: The number of patients treated was estimated to be 810,608 per year. The model predicted that the expansion of OROS® HM would lower the per patient drug cost from €592.28 to €590.88. Due to generic entry drug cost per patient was considerably lower than in the previous version of the model (€679.52). The model also predicts that if the prescription share of OROS® HM increased to 5% the total budget for strong opioids would decrease by €1,135,086. CONCLUSIONS: Our analysis suggests that under current circumstances our finding from 2008 that extending the use of OROS® hydromorphone to treat patients with severe chronic pain will reduce the overall budget spent on strong opioids is still valid.