OBJECTIVES: To estimate the cost-effectiveness of dopamine agonists such as pramipexole and piribedil on patients with early Parkinson's disease (PD). METHODS: Dopamine agonists have been added to treatment of 40 early PD patients that received amantadine and anticholinergics. A total of 18 patients (mean age: 58.3 ± 7.7 years, mean duration of disease: 2.6 ± 1.1 years) received pramipexole (mean dose: 2.4 ± 1.1 mg) within one year and 22 patients (mean age: 60.4 ± 5.6 years, mean duration of disease: 3.2 ± 2.2 years) received piribedil (mean dose: 168.2 ± 24.6 mg) within one year also. Clinical efficacy was measured by percentage reduction of Unified Parkinson Disease Rating Scale (UPDRS). Only direct costs were estimated. Cost-effectiveness ratio was defined for both agonists. RESULTS: After one year of treatment by dopamine agonists, 40 early PD patients had demonstrated significant (p<0.01) clinical improvement. Mean percent UPDRS score reduction from basic treatment was 12.2% in the pramipexole group of patients and 8.9% in the piribedil group of patients. Patients had no adverse effects which could lead to increase in cost of treatment. The mean cost for one-year treatment of pramipexole was $1544.29 compared to $506.96 of piribedil. Cost-effectiveness ratio for pramipexole group was $126.58 per 1% UPDRS score reduction, and $56.96 per 1% UPDRS score reduction for the piribedil group. CONCLUSIONS: Treatment of early PD patients by dopamine agonists such as pramipexol and piribedil resulted in significant clinical improvement. At the same time, use of piribedil is more cost-effective than use of pramipexole for early PD patients.