OBJECTIVES: To assess cost-effectiveness of CMV disease prophylaxis prolongation in kidney transplant recipients from 110 to 200 days from Polish public payer’s perspective. METHODS: Clinical efficacy and safety of prolonged to 200 days prophylaxis of CMV disease in kidney transplant recipients (D+/R-) was assessed in systematic review. Following measurable differential direct medical costs were estimated and included: costs of drugs and diagnostic, hospital/ambulatory procedures, adverse events treatment, acute rejection, CMV disease treatment, opportunistic infections treatment, hemodialysis and subsequent kidney transplantation. Cost data were gathered in 4 medical centers. Markov model was used to calculate costs and efficacy in 23.5 years time horizon - the maximum expected survival of kidney transplant recipient. Costs and clinical effects were discounted (5% for costs and effects, 0% for costs and effects, 5% for costs and 0% for effects). Probabilistic, one-way, multiway sensitivity analyses were conducted. RESULTS: The prolongation to 200 days of CMV disease prophylaxis in kidney transplant recipients is lined to reduction in frequency of CMV infections, acute transplant rejections, loss of graft functions and need of subsequent kidney transplantation. In the 23.5 years gain of 0.3846 life years and 0.3178 quality adjusted life years can be achieved. Total discounted costs in 23.5 years were 557 766.80 PLN (1EURO=3.96 PLN) for patients subjected to 200 days prophylaxis and 542 509.92 PLN for patients subjected to 110 days prophylaxis. The incremental cost-effectiveness ratio (ICER) was 39,669 PLN and cost-utility ratio (ICUR) 48,008 PLN. Sensitivity analysis confirmed the base case analysis results. The results were sensitive only to the time horizon assumed (when time horizon was shorter than 4 years ICER/ICUR were above the accepted 110,000 PLN cost-effectiveness threshold). CONCLUSIONS: The prolongation of CMV disease prophylaxis in kidney transplant recipients from 110 to 200 days is highly cost-effective from Polish payer perspective.