OBJECTIVES: To evaluate the cost-effectiveness of etoricoxib, a new selective Cox-2 inhibitor, in the treatment of acute gouty arthritis compared with indomethacin in the United Kingdom. METHODS: Using a recent clinical trial comparing etoricoxib with indomethacin in the treatment of acute gouty arthritis, a Markov model was built based on four 8-day treatment cycles spread over four years. In the trial, etoricoxib and indomethacin demonstrated equivalent efficacy but adverse event (AE) and treatment discontinuation rates favored etoricoxib. In calculating the total cost for each type of AE, its frequency in the trial was taken into account. The medical treatment of AEs and the average predicted probability of seeking treatment were obtained from expert opinion and used for the base case analysis. In the model, all patients suffering an AE or discontinuing treatment selected a different treatment for their next gout attack. The model further assumed a general practitioner would treat all patients and that an AE could necessitate one additional GP visit. RESULTS: After one cycle of treatment the incremental cost per patient successfully treated with etoricoxib (no AE or discontinuation), including drug therapy costs, was £15.43, decreasing to £6.27 over 4 cycles of treatment. CONCLUSION: In this study, etoricoxib was a cost-effective alternative to indomethacin for treatment of acute gouty arthritis based on the modelling calculations using published clinical trial data and conservative assumptions regarding the treatment of AEs.