OBJECTIVES: Pharmacological interventions that are of benefit in non-dialysis populations have thus far been disappointing in dialysis patients. Since clinical trials are expensive and time-consuming, adjunct strategies are needed to support decision making in prioritization of tracks for drug development. Genetic association studies may provide such a strategy when a genotype is associated with a well-defined molecular and functional phenotype. Previously an association with better survival was found in incident dialysis patients with systemic inflammation and a deletion variant of the CC-chemokine receptor 5 (CCR5Δ32). Thus, we hypothesized that pharmacological CCR5 blockade could protect against inflammation associated mortality and estimated if such a treatment would be cost-effective. METHODS: A screen-and-treat strategy was modelled in which patients were screened for the CCR5Δ32 polymorphism and patients with the wild-type genotype and high inflammation status were treated with CCR5 antagonists. A decision-analytic Markov model was used. Costs, utilities and clinical data on the association between CCR5 polymorphisms and mortality were all gathered from a single prospectively followed dialysis cohort (NECOSAD, n=413). Univariate and probabilistic sensitivity analyses were performed. RESULTS: Pharmacological CCR5 blockade in patients with CCR5 wild-type and high inflammation status decreased mortality (RR=0.61) and improved the probability of renal transplantation (RR=2.41). The cost-effectiveness of the screen-and-treat strategy was €18,557 per life-year gained and €21,896 per quality-adjusted life year (QALY) gained. The main drivers of the cost-effectiveness were the costs of pharmacological CCR5 blockade and the reduction in relative risk of mortality. Threshold analyses were performed for these two parameters. CONCLUSIONS: Pharmacological blockade of the CCR5 receptor in inflamed dialysis patients can be incorporated in a potential cost-effective genetic screen-and-treat program. This study illustrates the potential  of genetic association studies in drug-development programs, as a new source of Mendelian randomized evidence from an observational setting.