OBJECTIVES: The New Medicine Service (NMS) is a national community pharmacy service to support medicines-taking in people starting a new medicine for defined long-term conditions. The study investigated the expansion of NMS for patients with gout newly prescribed allopurinol as urate lowering therapy(ULT). Non-adherence with ULT is >60% in the UK,  METHODS: A probabilistic cost-effectiveness analysis from a NHS perspective was conducted to compare NMS (two follow-up consultations to identify and resolve medicines problems) with standard practice (SP) (usual supply without further follow-up).Treatment success was defined as patients reaching serum-uric-acid-levels <6mg/dL (sUA-controlled). A Markov model was developed to generate incremental cost-effectiveness ratios (ICER). Three health-states were included: sUA-controlled; sUA-uncontrolled; death. sUA-uncontrolled is associated with more acute gout attacks, higher mortality and is more likely in non-adherent patients. Cycle length was 1 year with a life-time horizon. Transition probabilities, resource use and utilities were derived from published studies. Costs and utilities were discounted at 3.5%. The results were plotted on an ICER-scatter-plane and presented as a cost-effectiveness acceptability curve (CEAC). RESULTS: mean (95% CI) cost per patient- NMS: £2569.43 (2203.69, 2935.17); SP: £2595.39 (2229.63, 2961.14) and mean (95% CI) QALYs generated per patient- NMS: 10.39 (10.10, 10.68) SP: 10.34(10.06,10.60) suggested that NMS dominated SP with increased QALYs (0.058 (-0.0008, 0.1168)) and reduced costs (-£25.96 (-81.37, 29.44). There was a 83.3% probability that NMS dominated SP and 98.4% probability that NMS was cost-effective at £20000 per QALY ceiling willingness-to-pay. CONCLUSIONS: NMS appears to be cost-effective when initiating ULT. It was assumed NMS would increase ULT adherence by 11% as in other diseases. NMS remained dominant down to an adherence increase of 5.4%. Reasons for ULT nonadherence matched the intervention design but further work is needed to assess the actual effectiveness of NMS in ULT.