OBJECTIVES: Diabetic nephropathy is the most frequent cause of End Stage Renal Disease (ESRD). As ESRD incidence continuously increases,  more resources are needed for treatment. The objective was to evaluate the economic impact of losartan added to the standard care administered to diabetic subjects with  ESRD. The analysis has involved more than 500million inhabitants. METHODS: We used standard methods to conduct  an economic evaluation comparing the economic outcomes deriving from the administration of losartan added to standard care versus standard care alone in patients with type2 diabetes mellitus (DM) and nephropathy over 3.4 years. The study was conducted from the perspective of the third party payer hence. The clinical outcome data were based on the results from the RENAAL trial. Direct medical costs are referred to the purchase costs of losartan and the cost of hospitalizations. The costs were discounted back at an annual rate of 3%. Also sensitivity analysis was performed. RESULTS: RENAAL study established that losartan confers strong renal protection in patients with DM and nephropathy. Losartan  results into a cost saving in all countries considered: 3 €602.98/Italy, €4,531.35/France, €3019.66/Germany, €3949.50/Switzerland and €3855.50/USA per patient. Results are not sensitive to both clinical and economic variables. CONCLUSIONS: In addition to the medical benefit, this analysis demonstrates the economic relevance of treatment with losartan in DM  patients with nephropathy.