OBJECTIVES: To assess the cost-effectiveness of pregabalin (PGB) and other add-on antiepileptic medicines over standard therapy (ST) in patients with refractory partial epilepsy (RPE) from the societal perspective in Finland. METHODS: A dynamic simulation model was used to estimate outcomes and costs of a hypothetical cohort of 1000 RPE patients over 1 year. Pregabalin (PGB 300 mg/d) was compared to clinically and commercially competitors: gabapentin (GBP 1800 mg/d), lamotrigine (LTG 300 mg/d), levetiracetam (LEV 2000 mg/d) and topiramate (TOP 200 mg/d). Number of seizure-free days (SFD) was used as an outcome measure. Local costs of RPE medicines (excluding VAT) and a specialist visit per a medicine switch were employed. Costs per a SFD were calculated. To account for uncertainty around the model estimates, the model was run for 50 samples. One-way sensitivity analysis (PGB 600 mg/d, TOP 400 mg/d or employment of generic GBP price) was conducted. RESULTS: In comparison to ST, PGB (300 mg/d) yielded an average of additional 40 SFDs per a patient during a year. Incremental cost for PGB was 29€ per a SFD (95%CI 23–36€). Corresponding estimate for PGB (600 mg/d) was 44€ per a SFD whereas it varied 43–86€ among the comparators. At the dose of 600 mg/d, the PGB incremental cost per a SFD was similar to GBP, but still lower than among other comparators. CONCLUSION: Principal findings from the model suggest that PGB (300 mg/d) showed to be a cost-effective add-on treatment for RPE patients in Finland compared to ST. The incremental cost of PGB (300 mg/d) per a SFD was lower than those of GBP, LTG and LEV with their typical doses. One-way sensitivity analyses indicated that the results were robust to plausible variations in the essential model parameters, namely daily dose of PGB and TOP and price of GBP.