OBJECTIVE: To evaluate the cost of treatment of FS in Italy and its determinants. METHODS: Multicenter retrospective cost of care study with patients enrolled from 28 Italian rheumatologic centers. Time: 12 months. Cost: we quantified direct costs attributable to FS management: drugs, hospitalisations, physicians’ visits, diagnostic tests, and other medical services (e.g. ionophoresis, mesotherapy, massage, thermal baths). Costs were estimated applying the National Health Service (NHS) tariffs expressed in Euro 2001. Perspective: NHS and patients perspective. RESULTS: We enrolled 402 patients with FS (mean age 48.4±12.3 years old), 94.8% women. The mean annual cost per patient was euro 880.1±1007.5: 33.7% attributable to hospitalisations, 17.45% to drugs and 17.7% to other pain coping strategies. Anti-inflammatory drugs were the mainly used drugs (72.1% of the patients used anti-inflammatory drugs). CONCLUSION: The cost of fibromyalgia treatment was estimated for the first time in Italy. The mean yearly cost is 880 euro and it is principally caused by high use of symptomatic drugs and other pain coping strategies.