OBJECTIVES: To assess the cost-effectiveness of using a lidocaine 5% medicated plaster in the treatment of post-herpetic neuralgia (PHN) compared with generic gabapentin (1800mg/day; 1200mg/day with add-in-medication) and pregabalin (PG; 300mg/day and 600mg/day; 300mg/day with add-in-medication) from the perspective of the German Sickness Funds. METHODS: A Markov model was constructed to calculate the cost-effectiveness of gabapentin, PG and lidocaine plaster in terms of the cost per quality-adjusted life-year (QALY) gained when used over a six-month time horizon in patients with PHN. The model structure allowed for differences in costs, utilities and transition probabilities between the initial 30-day run-in period and maintenance therapy. Most transition probabilities were based on clinical trials identified through a systematic literature review. Missing data, including resource utilization, were obtained from a Delphi panel and cost data were from official price tariffs/lists. Utilities derived from the literature were adjusted for age, and were supplemented and validated by the Delphi panel. RESULTS: The total cost of treatment with the lidocaine plaster was €937 per patient, compared with €728 for generic gabapentin, €875 for PG300mg and €975 for PG600mg. Lidocaine plaster generated 0.300 QALYs, compared with 0.247 for gabapentin, 0.253 for PG300mg and 0.256 for PG600mg. Lidocaine plaster therefore costs €3,943 (95% confidence interval [95%CI]: €997, €10,034) per QALY gained relative to gabapentin, €1,319/QALY (95%CI: dominant, €10,032) relative to PG300mg and dominated PG600mg (95%CI: dominant, €4,229). Probabilistic sensitivity analysis demonstrated that at a €20,000/QALY threshold, the lidocaine plaster is cost-effective relative to gabapentin with 99.75% confidence, 99.24% relative to PG300mg and 99.42% relative to PG600mg. Scenario analyses and extensive one-way sensitivity analyses on all parameters including the time horizon confirmed the robustness of the results. CONCLUSION: The lidocaine 5% plaster is a highly cost-effective treatment for PHN in Germany.