OBJECTIVES:: To evaluate the cost-effectiveness of 5% medicated patch compared with pregabalin or gabapentin in patients with post-herpetic neuralgia (PHN) and diabetic polyneuropathy (DPN) in Colombia. METHODS:: A Markov model was constructed for clinical outcomes, quality of life, and total costs; the analysis was performed from the third-party payer perspective, with a time horizon of 6 months, including treatment costs and adverse events. The cost information was valued in Colombian pesos (COP) in 2016 using official sources. The measure of effectiveness was estimated by QALYs. Univariate sensitivity analysis, changing 6 key parameters, was performed. RESULTS:: In the baseline scenario, monotherapy and combination therapy are highly cost-effective with an ICER below one Colombian per capita GDP (US $ 5,209; 1 US $ = 3,051 COP in 2016). The comparison of lidocaine medicated patch vs. pregabalin in monotherapy yielded the highest ICER with a value of US $ 4,880 per QALY gained. These results are similar in the case of DPN management, where the highest ICER was US $ 4,988 per QALY gained. When the univariate sensitivity analysis was performed applying variations to the time horizon, number of patches used, dosages and drug prices, the results appeared to be consistent, given that in most of scenarios patches presented a lower ICER than three Colombian per capita GDP (US $ 15,627). CONCLUSIONS:: The treatment of NPH and DPN with 5% lidocaine medicated patch in monotherapy and in combination therapy plus pregabalin, results highly cost effective strategy for the Colombian healthcare system.