OBJECTIVES: To determine cost-utility of Sabril®in the treatment of drug-resistant epilepsy compared to lamotrigine, gabapentin, topiramate, tiagabine, oxcarbazepine or levetiracetam in Polish conditions. METHODS: In order to determine long-term costs and health effects of interventions, a Markov model was built and it assumed two-step treatment of epileptics. The Cost Effectiveness Analysis Registry Database was searched to find health state utilities. Costs in the analysis were presented from Polish payer’s perspective, in lifetime horizon which was divided into 3-month cycles. Only direct medical costs regarding 1st and 2nd line drug costs, diagnostic costs, ambulatory and hospital treatment were taken into account. Costs and health effects were discounted at 5% and 3.5% rate, respectively. A cost-utility analysis was conducted for comparison with gabapentin and lamotrigine while a cost-minimisation analysis was an analytical technique for comparisons with topiramate, tiagabine, oxcarbazepine and levetiracetam. Cost of adverse events after vigabatrin administration was not taken into consideration due to heterogenous information about risk of adverse events. RESULTS: Epilepsy therapy with vigabatrin brought 0.0172QALYG comparing to gabapentin however it was more expensive by 1526.75PLN. The administration of lamotrigine was less costly in reference to vigabatrin (by 532.45PLN) and health effects of treatment with lamotrigine were superior (by 0.0091QALY). Incremental costs of vigabatrin administration were positive in comparison to topiramate and tiagabine (3637PLN and 1831PLN) and negative in reference to oxcarbazepine and levetiracetam (-1461PLN and -2942PLN). CONCLUSIONS: The administration of vigabatrin in drug-resistant epilepsy was cost-effective in comparison to gabapentin however it was dominated by treatment with lamotrigine. Epilepsy therapy with vigabatrin was more expensive than treatment with topiramate or tiagabine while it was less expensive treatment option than the administration of oxcarbazepine and levetiracetam.