OBJECTIVES: To compare costs and effectiveness of pregabalin compared to placebo in the treatment of central neuropathic pain (CNP) from the perspective of the public healthcare payer in the Czech Republic. METHODS: A de novo micro-simulation model was developed in MS Excel comparing pregabalin treatment of CNP versus placebo as there is no other treatment of CNP available and reimbursed in the Czech Republic. The improvement of patients’ pain intensity expressed as the decrease in VAS (Visual Analog Scale (0-100) score was modelled during the 24 week time horizon. The changes of VAS score were estimated for each intervention using a regression functions of time and the baseline VAS score. Utilities were assigned to each VAS score according to the regression equations expressing the dependence of utility value on average weekly VAS score of CNP patients. Relevant costs (reflecting payer’s perspective) were defined as costs of pharmacotherapies, outpatient care related to drug application, management of treatment, treatment of adverse events and concomitant medication were considered.  RESULTS: The incremental cost-effectiveness ratio (ICER) of pregabalin compared to placebo reached 8,335.22 EUR per Qualy-adjusted-life-year (QALY) gained. The probability of pregabalin being cost-effective (ICER under willingness to pay 39,876.74 EUR) was 100%. CONCLUSIONS: Pregabalin is the only option for the treatment of CNP in the Czech Republic and brings significant pain relief for patients. Treatment with pregabalin also results in low ICER and can be considered a cost-effective treatment of central neuropathic pain in the Czech Republic.