OBJECTIVES: To evaluate the cost-effectiveness ratio of antiparkinsonian medication taken as monotherapy in patients with Parkinson’s disease (PD). METHODS: A cost-effectiveness analysis (CEA) of therapies including pramipexole ER, pramipexole, ropinirole, piribedil and rasagiline has been performed.  Direct medical costs including costs of medications and treatment of adverse drug effects for 1-year therapy of PD have been considered. The clinical effect of selected antiparkinsonian medication was assessed in percentage of patients responding to treatment, and also by means of the UPDRS II-III scale. All calculations were done in RUR prices of 2013 (nominal exchange rate RUR/USD = 30/1). RESULTS: Pramipexole ER has the lowest cost-effectiveness ratio (CER) of RUR 57,572 per patient/year responding to antiparkinsonian therapy. Hence, pramipexole ER was the most effective antiparkinsonian preparation studied in pharmacoeconomic terms. Based on cost-effectiveness ratio, the medications evaluated can be arranged in the following order: pramipexole ER (RUR 57,572), pramipexole (RUR 59,548), piribedil (RUR 70,921), ropinirole (RUR 71,887), and rasagiline (RUR 91,112). The model results were robust to deterministic sensitivity analysis with variable drug costs. Limitations: Absence of direct comparative evidence from randomized, double-blind, controlled studies makes interpretation of the data difficult. Only short-term studies (up to 24 months) were available and hence do not allow to evaluate the influence of pharmacotherapy on motor fluctuations as well as other longterm factors. CONCLUSIONS: The results of the present pharmacoeconomic analysis indicate that pramipexole ER is cost-effective as first line therapy for the treatment of early stages of Parkinson’s disease from a Russian healthcare perspective. All five formulations evaluated, are well below the conditional “willingness to pay ratio” (equal to RUR 1,308607 in 2012). Hence, these preparations would qualify for application in the Russian system of public reimbursement.