OBJECTIVES:  To evaluate the cost-effectiveness of the use of 5% lidocaine medicated plaster (LMP) monotherapy, compared with pregabalin and gabapentin, in the treatment of postherpetic neuralgia (PHN) and diabetic polyneuropathy (DPN) in the Brazilian public healthcare system. METHODS:  A systematic review was performed to compare the use of LMP with placebo or active comparators on neuropathic pain management. Based on the results, disease and efficacy data were selected. PHN and DPN were the most studied neuropathic pain conditions and therefore selected. Since both diseases were evaluated together, the same structure could be used for both analyses, with minor adaptations. Two comparators were selected: pregabalin, the main comparator in clinical trials, and gabapentin, the most used drug in clinical practice. A Markov model was built based on published cost-effectiveness studies, and consisted of 6 states covering treatment, adverse events and discontinuation. The time horizon had 6 months with monthly cycles. Transition probabilities were extracted from clinical trials, head-to-head for pregabalin and placebo controlled for gabapentin. Benefits were measured in quality-adjusted life-years (QALYs), to account the improvement in adverse events. Resource use was retrieved from literature and direct medical costs were estimated based on public sources. A one-way sensitivity analysis was performed to evaluate model’s robustness. Values were expressed in 2016 BRL. RESULTS:  Incremental cost-effectiveness ratio (ICER) of LPM versus pregabalin and gabapentin were 19,256.33 BRL/QALY and 19,102.47 BRL/QALY for PHN, and 19,244.16 BRL/QALY and 23,208.75 BRL/QALY for DPN. All results from the sensitivity analysis were below the threshold recommended by WHO of 1 GDP per capita (27,229.00 BRL), and the most sensitive parameter was the mean number of plasters used. CONCLUSIONS: LDM monotherapy was considered highly cost-effective for the treatment of PHN and DPN compared with pregabalin or gabapentin in the Brazilian public healthcare system.