With increasing health service cutbacks, cost-effectiveness is a central issue in many wound care decisions. Clinicians are frequently required to justify clinical decision making in terms of health benefits obtained and the cost to health service providers. However, few clinicians have the skills to accurately interpret cost in more than local health economic terms, and the disjointed structures that exist in healthcare provision mean that even those who monitor health expenditure have little concept of the global cost of care provision. This article focuses on the pressures placed on healthcare providers to achieve cost-effectiveness in care, specifically in relation to wound care and the effect that pain at dressing change has on the cost of care.