OBJECTIVES:  Failed back surgery syndrome (FBSS) is a cause of major morbidity and quality of life impairment. Conventional medical management (CMM) can help to relieve symptoms but many patients do not achieve satisfactory pain relief. Spinal cord stimulation (SCS) is an evidence-based effective treatment option for eligible patients with persistent pain. Our objective was to determine the cost-effectiveness of SCS in combination with CMM, versus CMM alone, in patients with FBSS refractory to CMM, from a Dutch payer perspective. METHODS:  We adapted a Markov model developed for the UK, updating unit cost and mortality inputs with Dutch data. The model assigned patients to health states according to level of pain relief and the presence of complications, captured changes in quality of life and covered a range of direct cost categories, including: device acquisition and implantation, adverse event management, drug therapy for pain, non-drug follow-up visits, repeat spinal surgery and device replacements (the use of both rechargeable and non-rechargeable devices were modelled). A 15-year time horizon was used, with costs and QALYs discounted at 1.5% and 4% per year, respectively. RESULTS:  In the base-case analysis, the model predicted an incremental cost-effectiveness ratio (ICER) of €19,761 per QALY gained. Sensitivity analyses were carried out on a range of parameters; in no scenario did the ICER exceed €35,000 per QALY gained. CONCLUSIONS:  The results suggest that SCS is a cost-effective intervention in this patient population, leading to improved health outcomes at acceptable additional cost. In all scenarios tested, the ICER was within the cost-effectiveness threshold used in the Netherlands, indicating that the model is robust to changes in the input parameters. Incremental improvements in device longevity and the increasing use of rechargeable devices result in lower ICERs. Real-world clinical evidence from the Netherlands would be a useful addition to this model.