Objective: The treatment of chronic kidney disease (CKD) with dialysis is associated with the appearance of hyperphosphatemia, which contributes to the presence of vascular calcifications, thus increasing the probability of the occurrence of cardiovascular events and death in these patients. The objective of this analysis was to evaluate the incremental cost-effectiveness of the use of sevelamer to manage hyperphosphatemia secondary to CKD from an institutional perspective. Methods: A Markov model was created in TreeAge to estimate the costs and benefits of the treatment with sevelamer or calcium tablets in patients with renal failure considering a temporary horizon of 60 months. The transition probabilities were taken from clinical trials identified through a systematic review of literature. The effectiveness measure considered was an increase in patient survival. Data related to the use of resources were obtained from a nominal group and cost information was obtained from price lists and rates published by health institutions. In addition a univariate sensitivity analysis was performed on the probability of death for sevelamer group. Costs were estimated using 2007 prices and are expressed in US dollars (exchange rate of 10.93 pesos per US dollar). Results: Survival of patients with CKD increased in 18.4% in the sevelamer group, compared to the calcium group (83.12% vs. 64.72%). The expected average monthly cost was $639 for calcium and $989.50 for sevelamer. The Cost-Effectiveness Ratio of sevelamer and calcium was $1068 and $777.70, respectively, and the Incremental Cost-Effectiveness Ratio for the implementation of sevelamer vs. calcium was $3343.50 Conclusion: Sevelamer is a cost-effective drug for the treatment of hyperphosphatemia in patients with chronic kidney disease in the Mexican context