Neurocysticercosis (NCC) is a major cause of neurological morbidity in the developing world. This study aimed to assess the treatment costs and productivity losses associated with NCC in Peru. NCC patients were identified through retrospective chart analysis. Patients meeting inclusion criteria were interviewed in order to obtain data on symptom history, treatment costs, productivity losses and health service utilisation patterns. These data were modelled to determine average treatment costs and productivity losses over 2 years. Our findings show that treatment costs and productivity losses consume 54% of an annual minimum wage salary during the first year of treatment and 16% during the second year. Diagnosis (36%) and drug therapy (27%) represent the most expensive healthcare-related costs. These costs are prohibitive for some-8% of our study sample had no diagnostic tests during their first 6 months of disease, and two-thirds of those who delayed treatment reportedly did so due to their inability to pay. Two-thirds of wage-earners lost their jobs owing to NCC and only 61% were able to re-engage in wage-earning activities. This study highlights the need to expand financial coverage to ensure the poor have access to health services and do not become further impoverished. © 2007 Royal Society of Tropical Medicine and Hygiene.