OBJECTIVES: Fibromyalgia is a disorder often characterized by chronic musculoskeletal pain over multiple regions of the body not explained by anatomical injury.  Pregabalin is the only approved medication for fibromyalgia in Taiwan.  This study aims to estimate the cost-effectiveness of pregabalin for treatment of severe fibromyalgia in Taiwan.   METHODS: A decision-analytic model was constructed for projecting the effects and costs of pharmaceutical treatment of fibromyalgia sufferers in Taiwan.  Treatment comparators and utilization patterns were provided through local physician questionnaires and a national key opinion leader advisory board (rheumatologist, pain specialists and neurologist).  Costs were collected from local published data.  Response (30% improvement over baseline in pain score and patient global impression) and non-response of a single patient were modeled to pregabalin 300mg or 450mg versus placebo and alternative medications used in practice as suggested by the advisory board (amitriptyline 25mg, duloxetine 60/120mg, tramadol 200mg, or gabapentin 1800mg) for 12 weeks, followed by a three-year Markov model depicting maintained response, lost response, or stopped treatment.  Transition probabilities were retrieved from published randomized trials.  Effectiveness was quality-adjusted life years (QALYs).  Costs and QALYs were annually discounted at 3%.  Annual costs were reported in 2013 US$.   RESULTS: The base case patient was a 42 year old woman.  Compared pregabalin 300mg and 450mg with placebo, the incremental cost-effectiveness ratios (ICERs) were $33,369/QALY and $49,040/QALY.  The ICERs for pregabalin 300mg versus duloxetine 60mg/120mg, tramadol, or gabapentin were $33,009/QALY, $3,377/QALY, $189,956/QALY, and $36,318/QALY, respectively.  The ICERs for pregabalin 450mg versus duloxetine 60mg, duloxetine 120mg, tramadol, or gabapentin were $63,970/QALY, $39,697/QALY, $237,612/QALY, and $66,755/QALY, respectively.  Both pregabalin 300mg and 450mg had higher cost and lower QALYs than amitriptyline.  The results are robust under probabilistic sensitivity analysis. CONCLUSIONS: Depending on a budgetary authority’s willingness to pay, pregabalin may be cost-effective against placebo and alternative treatments.