OBJECTIVES: To assess the cost-effectiveness of the Versatis lidocaine 5% medicated plaster relative to 300 and 600mg/day pregabalin in the treatment of post-herpetic neuralgia (PHN) from the perspective of the Scottish National Health Service. METHODS: The costs and benefits of the three treatments were assessed over a six-month time horizon using a Markov model. The model structure allowed for differences in costs, utilities and transition probabilities between the initial 30-day run-in period and maintenance therapy and took account of add-in medication and drugs received by patients discontinuing therapy. Transition probabilities were based on clinical trials and Delphi panel estimates. Resource use and add-in/switch medications were obtained from 2 Delphi panels; cost data were from official price tariffs. Published utilities were adjusted for age and were supplemented/validated by a Delphi panel. Lidocaine-treated patients were assumed to receive 1.03 plasters/day based on US prescribing data. RESULTS: The average patient receiving the lidocaine plaster accrued 0.292 quality-adjusted life-years (QALYs) over six months – 0.067 more than 300mg pregabalin and 0.061 more than 600mg pregabalin. The total treatment cost for patients receiving the lidocaine plaster (£681/patient) was very similar to that for 300mg pregabalin (£636/patient) and 600mg pregabalin (£655/patient). The lidocaine plaster cost £674/QALY (95% confidence interval [95%CI]: dominant, £4,780) relative to 300mg/day pregabalin and £434/QALY (95%CI: dominant, £5,009) relative to 600mg/day pregabalin. Probabilistic sensitivity analysis demonstrated that we can be 99.9% confident that the lidocaine plaster is cost-effective relative to 300mg pregabalin and 99.8% confident that it is cost-effective relative to 600mg pregabalin at a £20,000/QALY threshold. The lidocaine plaster cost £27 per additional month with sufficient pain relief and no intolerable side-effects relative to 300mg pregabalin and £18/month relative to 600mg pregabalin. CONCLUSION: The Versatis lidocaine 5% medicated plaster is a highly cost-effective alternative to pregabalin for the treatment of PHN in Scotland.