OBJECTIVES: To assess the cost-effectiveness of tapentadol compared to oxycodone and morphine as 1st line strong opioid therapy in chronic non-cancer pain (CNCP) patients in Sweden. METHODS: A Markov transition state model over one year with cycle times of one month was built. Four health states were defined: 'occurrence of adverse events (AEs) with need for medical treatment', 'withdrawal due to AEs', 'response to therapy ' and 'death'. If patients did not adequately respond to tapentadol or comparators or withdrew, switching to alternative 2nd line opioid (oxycodone, morphine or transdermal fentanyl) was considered. After initiating 3rd line therapy, patients could stay on this therapy or die according to morbidity rate. Data regarding efficacy, tolerability and utility values (EQ-5D) were derived from clinical trials and published literature. Switch rates to subsequent opioid therapies and resource consumption were estimated by clinical experts. Costs were calculated from the societal perspective. Direct costs were calculated based on official Swedish prices/tariffs, indirect costs were calculated based on figures obtained from the literature and current wage rates. Costs and benefits were not discounted in base case calculation. Impact of selected parameters on the results was evaluated in one-way sensitivity analyses (OWSA). RESULTS: Mean annual total costs per patient amount to 242,583 SEK (Swedish krona) for tapentadol vs. 247,813 SEK for oxycodone and 246,093 SEK for morphine. Tapentadol generates 0.4712 QALYs compared to 0.4518 QALYs for oxycodone and 0.4535 QALYs for morphine. More QALYs generated in the model reflect tapentadol’s better tolerability profile than comparators. Cost parameter comprising physician visits, co-medications and non-drug therapy costs revealed highest impact in OWSA. CONCLUSIONS: Tapentadol, once approved, will generate more QALYs at lower costs than oxycodone and morphine. Tapentadol appears to be the favourable treatment option in the 1st line therapy of CNCP patients in Sweden from a societal perspective.