OBJECTIVES: This study aims to provide the results from a cost-minimization (CM) model that compares the use of dienogest with the use of GnRH antagonist (GnRHa) leuprorelin acetate, both for 6 months, in women with endometriosis-associated pelvic pain (EAPP) in Brazil. METHODS: A(CM) model was developed in the form of a decision tree to mimic treatment sequence in Brazil. The analysis was conducted under the private and public payer perspectives, only direct costs were included, procedures and drug costs were obtain from Brazilian official databases of public and private healthcare system fees. This CM model compared different treatment pathways for women with EAPP and used a 50% improvement in pelvic pain as a definition of a treatment responder to elicit treatment duration. Treatment response assessment was at 12 week period. Two basic treatment pathways were defined: a two treatment sequence (2TS) and tree treatment sequence (3TS). The 2TS consists of: GnRHa/dienogest followed by surgery. The 3TS consists of: GnRHa/dienogest, dienogest/GnRH as second treatment and surgery as final option. Subsequent treatments were only for patients that did not respond to previous treatment. Discount was not applied as costs occurred within 1 year period. RESULTS: The CM model shows that for both treatment pathways and perspectives dienogest is a cost-saving alternative.  Under private payer perspective for 2TS and 3TS: BRL 1020.42 VS BRL 2328.94 and BRL 1461.22 VS BRL 2377.52 for dienogest and GnRHa respectively. Under public payer perspective for 2TS and 3TS: BRL 882.74 VS BRL 768.13 and BRL 942.18 VS BRL 856.77 for dienogest and GnRHa respectively. Efficacy for 2TS and 3TS are: 91.58% and 97.87% respectively. CONCLUSIONS: This analysis portends dienogest as a cost-saving alternative for the treatment of EAPP compared to GnRHa in Brazil from the public and private payer perspective.