Objective: To determine the incremental cost-utility ratio (ICUR) of Sativex®, a novel, cannabis-based therapy, as adjunctive treatment for neuropathic pain in MS adults from a Canadian provincial government payer perspective over a one-year time horizon. Methods: Efficacy and safety of Sativex® were extracted from the pivotal phase III trial comparing Sativex®+standard analgesic care (SAC) to SAC alone. Direct medical resources (medication, health professionals, lab and diagnostic) were taken from a burden of illness study. Sativex® utilization for the economic analysis was based on the utilization in the pivotal study (# sprays per day). Costs (2006 CND$) were based on provincial sources. Utilities were based on a mapping exercise whereby pain severity (BS-11) from the pivotal trial was mapped onto Health Utilities Index Mark 3 (HUI) pain attribute level. The primary outcome was the cost per additional quality adjusted life year (QALY). The incremental cost per additional pain-controlled day was a secondary economic outcome. Sensitivity analyses were conducted to investigate the robustness of the results. Results: The total direct cost of treatment over one-year was $12,691 for Sativex®+SAC and $3,340 for SAC. The total QALYs for Sativex®+SAC were 0.3793 and 0.2459 for SAC. The ICUR for Sativex®+SAC compared to SAC was $70,103/QALY. The number of pain controlled days over a one-year time horizon was 196 for Sativex®+SAC and 122 for SAC. Cost drivers were Sativex® utilization (5 daily sprays=$36,512/QALY; 11 sprays=$80,327/QALY). The incremental cost per pain-controlled day was $127. Conclusion: Results indicated that Sativex® + SAC was more expensive than SAC, but provided increased QALYs and pain-control in MS patients with neuropathic pain.