OBJECTIVES:: There are only two strong opioids available in the Brazilian public healthcare system (SUS): morphine and methadone, which may lead to a small range of therapeutic options, therefore poor pain management in oncologic patients. This study aims to calculate the cost-effectiveness of oxycodone versus morphine for patients who had not responded to morphine from the Brazilian public payer perspective. METHODS:: For calculating the cost-effectiveness of oxycodone versus morphine, we built a cost-per-responder model, which considered only drug-related costs, since the drugs have no differences in terms of drug administration cost (both drugs are orally administered) and studies did not reported differences in terms of costly adverse events between morphine and methadone. Morphine’s price was obtained through search in the Brazilian official drug prices database (BPS). Mean prices per tablet are BRL (Brazilian Reais) 0.31 and BRL 0.87 for 10 mg and 30 mg presentations, respectively. Oxycodone´s price was assumed to be the one submitted for Brazilian HTA agency (CONITEC): BRL 6.71, BRL 12.03 and BRL 20.47 per tablet for 10 mg, 20 mg and 40 mg presentations, respectively. Posologic regimens were obtained in the labels approved by the Brazilian drug regulator (ANVISA). Efficacy data was obtained through the clinical trial published by Narabayashi and colleagues. RESULTS::  The calculated number needed to treat (NNT) for oxycodone versus morphine was 1.27. The cost-effectiveness model of oxycodone versus morphine resulted in five thousand BRL per responder. CONCLUSIONS::  Despite lack of official willingness-to-pay threshold, oxycodone seems to be a cost-effective option, given BRL 5k certainly is a low value considering health benefits derived from pain management in suffering and frequently end-of-life patients.