OBJECTIVES: Patients refractory to older therapies for neuropathic pain (NeP) have few remaining therapeutic options. To demonstrate pregabalin's value to decision-makers, this study evaluates the cost-utility of pregabalin in the treatment of patients with refractory neuropathic pain in Sweden, from a healthcare and societal perspective. METHODS: A discrete event simulation (DES) model was constructed to compare pregabalin with usual care. Pain profiles were generated for the pregabalin and usual care cohorts using clinical data from a synthesis of five non-randomised pregabalin studies in treatment-refractory patients. Utility data were generated from a UK survey of patients with NeP, which were used in a recent successful Health Technology Assessment (HTA) of pregabalin in the UK [1]. Cost data were generated from the Swedish TLV’s product price database, a national NeP register, and a regional register study. Indirect costs were estimated from published sources. One-way, and probabilistic sensitivity analyses (PSA), evaluated uncertainty in the model’s output. RESULTS: The incremental cost-effectiveness ratio (ICER) for pregabalin compared to usual care was 51,616 SEK/€5,364 (123,993 SEK/€12,886 excluding indirect costs). One-way sensitivity analyses confirmed the clinical input data as the main driver of the model; even considerable changes to all other input parameters had only a modest effect on the ICER. The PSA generated an ICER of 41,634 SEK/€4,327 (with indirect costs included), suggesting that the model is relatively insensitive to the combined variation in all input parameters; this is evident in the ICER scatter, in which the cost-effectiveness pairs are tightly grouped. CONCLUSIONS: Our study found pregabalin to be highly cost-effective compared to usual care in Swedish treatment-refractory patients. Moreover, the PSA showed pregabalin’s favourable cost-effectiveness to be robust in all modelled scenarios, with an ICER well below a conservative threshold of 347,495 SEK /€36,113/£30,000. [1] Scottish Medicines Consortium (SMC). Pregabalin re-submission, advice issued May 2009.