OBJECTIVES: Once daily tacrolimus (OD) revealed better compliance and adherence in post-transplant patients compared to twice daily tacrolimus (BD). Higher adherence on immunosuppressant therapy revealed lower rate of rejection, hence lower consumption of dialysis and re-transplantation. We assessed cost-effectiveness of tacrolimus OD vs. tacrolimus BD in treatment of post-renal transplant patients in 15 year horizon. METHODS: We developed a Markov cohort model (using TreAge PRO 2012) with 1-year cycle length with Life-Years-Gained (LYG) as an outcome; the model reflects health insurances’ perspective. We used literature derived time-dependent probabilities of transitions among particular health states (incl. mortality). Patients enter the model after successful kidney transplantation. We identified following health states: Graft survive, Acute graft rejection (AR), Post-rejection, Dialysis, Re-transplantation. Patients may Die from each state. Drug acquisition cost of tacrolimus OD was 10% higher compared to BD, other costs of AR (1,799€), dialysis (33,675€) and transplantation (16,631€) were derived by an expert panel and local pricing lists. The costs and outcomes were discounted by 3% rate. We performed One-Way-Sensitivity (OWSA) and Probabilistic-Sensitivity (PSA) analyses using 20% deviation from base-case. RESULTS: The model predictability, in term of patients’ survival within 15 year horizon, was validated according to mortality data in several kidney transplant patients’ registries. The deterministic results in 15 year horizon showed that tacrolimus OD generated costs of 67,457€ (10.714 LYG) and tacrolimus BD 68,316€ (10.581 LYG), tacrolimus BD revealed incremental costs of 859€ and -0.133 LYG. PSA showed 96.7% probability of tacrolimus OD being dominant and 3.3% below defined threshold of 1 GDP/ capita in the Czech Republic. CONCLUSIONS: Tacrolimus OD is dominant intervention (lower costs and simultaneously higher outcomes) despite 10% higher acquisition costs compared to tacrolimus BD. OWSA showed that the results were the most sensitive on tacrolimus acquisition cost, compliance rate and cost of dialysis.