OBJECTIVES:  To evaluate the cost-effectiveness of rotigotine transdermal patch as monotherapy in early-stage Parkinson’s disease (PD) compared to ropinirole and other dopamine agonists (DA) from the NHS perspective in Scotland. METHODS:  A decision-analytic model was developed, based on treatment of an early-stage PD patient (Hoehn and Yahr-stage 2); treatment arms were rotigotine, ropinirole, and a DA practice comparator including ropinirole, cabergoline and pramipexole. 5-year and 10-year time horizons were considered for patients who remained on monotherapy only. The economic evaluation is a cost-utility analysis with health outcomes expressed in Quality Adjusted Life Years (QALY) gained in 2006. Costs relating to drug acquisition, PD severity, falls, occurrence of motor complications and other complications/adverse events/co-morbidities were considered in the model. Efficacy and safety data were estimated with a meta-analysis. Quality of life was measured using EQ-5D. Data on medical resource use was obtained via expert interviews and literature review. Costs and effects were discounted at the rate of 3.5%. RESULTS:  After 5 years, treatment with rotigotine transdermal patch resulted in an estimated 2.30 QALYs, slightly higher than with ropinirole (2.26) and the DA practice comparator (2.27). 10-year outcomes were 3.22, 3.17 and 3.17 QALYs for rotigotine, ropinirole and DA practice comparator, respectively. Total costs for rotigotine, ropinirole and DA practice comparator were £34,748, £37,694 and £36,459 respectively after 5 years and £79,477, £84,120 and £81,631, respectively after 10 years. With a willingness-to-pay of £20,000 per QALY gained, there is a 90% probability that rotigotine is cost-effective relative to ropinirole, and a 85% probability of cost-effectiveness relative to the DA practice comparator for both 5-year and 10-year time horizons. CONCLUSIONS: Based on the model, rotigotine may be considered a dominant strategy over ropinirole and DA practice comparator in the treatment of early-stage PD at 5-year and 10-year time horizons.