OBJECTIVES: Adding pregabalin or gabapentin to existing therapy in patients with painful radiculopathies in routine medical practice in a Spanish health care setting. METHODS: A retrospective database analysis was performed using patients’ medical claims records from BSA. Medical records from male and female, with cervical, dorsal or lumbar painful radiculopathy, >18 years, in whom pregabalin, or gabapentin was initiated between 2006 and 2008 were included in the analysis. The economic analysis included healthcare resource utilization and corresponding costs from a third-payer perspective. Estimates of indirect costs, due to sick leave were also included. RESULTS: A total of 571 records were eligible for analysis: 378 (66.2%) treated with pregabalin and 193 (33.8%) gabapentin. Time since diagnosis, duration of treatment, prevalence of most comorbidities and previous use of analgesics were comparable. However, concomitant use of analgesics was higher in gabapentin cohort; 3.1 (1.7) versus 2.8 (1.8); p<0.05, mainly due to a higher utilization of opioids (31.1% vs. 21.2%; p<0.05) and non-narcotic (63.7% vs. 52.1%; p<0.01) drugs. Adjusted total costs per patient were significantly lower in pregabalin group; €2472 (2101-2836) versus. €3346 (2866-3825); p= 0.005, due to minor absenteeism costs; €1012 (658-1365) versus €1595 (1129-2062); p=0.042, and lower adjusted health care costs; €1,460 (1,360-1,560) versus €1750 (1618-1882); p=0.001. The higher drug acquisition costs for pregabalin [€343 vs. €222; p<0.001) was largely compensated for by lower overall health care costs, mainly in primary care medical visits, hospitalization days and concomitant analgesics. CONCLUSIONS: In a population setting in Spain, pregabalin treated patients with painful radiculopathies were considerable less costly for the health care provider than those treated with gabapentin in routine clinical practice. The higher acquisition cost of pregabalin was compensated largely by lower costs in the other components of health care costs. Patients treated with pregabalin had significantly less sick leaves than gabapentin treated patients.