OBJECTIVES: To determine the most cost-effective alternative between a) Losartan, and b) Losartan + Aliskiren in type 2 diabetes and hypertension patients with microalbuminuria in the Mexican Institute of Social Security. METHODS: A complete economic evaluation was performed from institutional perspective, using a Markov model as analytical tool with semi-annual cycles and follow up until death, with transversal analyses at 10, 15 and 20 years. Simulating a cohort with a 53 years old patient with type 2 diabetes, hypertension, and microalbuminuria and using a discounting rate of 5% in costs and effectiveness. One assumption is that all patients that require dialysis receive it. Proportion of patients who have not received dialysis, as well as survival and quality of life were considered as effectiveness end points. Transition probabilities were obtained from AVOID study and IMSS information. Resource use was obtained from IMSS data and costs are considered in 2009 USD. Probabilistic and non-probabilistic sensitivity analysis was performed. RESULTS: Keeping a patient in stages prior to dialysis at 20 years of follow-up requires an investment of $19,647 with Losartan and $18,774 with Losartan + Aliskiren.  After 14 years of follow up, Aliskiren + Losartan is dominant versus the use of Losartan. CONCLUSIONS: Aliskiren + Losartan is a cost-saving alternative if administered for prolonged periods, being the most effective regardless the period of monitoring and effectiveness measurement used.