BACKGROUND: Parkinson's Disease (PD) is a central nervous system disorder caused by progressive deterioration of brain areas that produce dopamine. Oral dopaminergic therapies control the symptoms of the disease, but these require three or more times daily doses, so it is associated with poor compliance or adherence, which affects the overall efficacy and costs in health. OBJECTIVES: To analyze the cost-effectiveness of rotigotine versus pramipexole in patients with PD in Mexico. METHODS: We conducted an economic evaluation. The alternatives to compare were rotigotine 4, 6, 8 and 12 mg administered once daily versus pramipexole 3 mg/d and another scenario versus pramipexole 4.5 mg/d. The perspective is the Mexican Social Security Institute. The model included the cost of drug acquisition and management of adverse events (AE) for a 22 weeks period. The measure of efficacy was compliance or adherence to treatment, as a direct comparison study of rotigotine versus pramipexole demonstrated non-inferiority between the two alternatives. RESULTS: The compliance rate for rotigotine was 81% vs 61% pramipexole. The costs were US$748, US$920, US$1113 and US$1701 for rotigotine 4, 6, 8 and 12 mg/d respectively, compared with US$670 and US$967 for pramipexole 3 and 4.5 mg/d. The cost per successfully treated patient was lower for rotigotine 4, 6 and 8 mg/d (US$923, US$1 136 and US$1374, respectively) than with pramipexole 4.5 mg/d (US$1585). Rotigotine 4, 6, 8 and 12 mg/d were found to be a highly cost-effective strategy compared with pramipexole 3 and 4.5 mg/d, according to WHO criteria. CONCLUSIONS: The results of this analysis suggest that the use of rotigotine in patients with PD, represents a highly cost-effective strategy or cost saving for the public health institutions in Mexico. Rotigotine is an innovative alternative for easy administration (transdermal).