OBJECTIVES: The INDEPENDENT study showed for the first time a significant reduction in mortality associated with Sevelamer, a phosphate binder, compared to Calcium Carbonate, in  stage 3-4 nondialysis-dependent CKD patients. We evaluated the impact on CKD related hospitalizations in order to assess the cost-effectiveness profile from the NHS perspective. METHODS: The INDEPENDENT study involved 107 (Sev) and 105 (CaC) patients with a 36 months follow-up. Since few of them started dialysis, we also performed a subgroup secondary analysis on patients remaining dialysis free (76 vs 63). Individual hospitalizations in Nephrology, Cardiology and ICU were recorded as well the overall length of stay over the observation period. Correlated consumption of drugs, such as alpha and beta blockers, ARBs, ACE inhibitors, calcium channels blockers and erythropoietin, was also assessed. For hospitalizations and drugs, DGR tariffs and hospital acquisition cost respectively were used. As effectiveness end-point we considered the number of averted deaths. RESULTS: Calcium-treated patients were associated with greater frequencies of admission in all departments, thus generating significantly higher costs. The average savings generated by reduced hospitalizations far exceeded the acquisition cost of Sevelamer. In case of hospitalization, Sevelamer-treated patients showed a substantial reduction in the overall length of stay (-5.9 days, p=0.012). Such difference was also present in the secondary subgroup (-5.5 days, p=0.13). After 1000 bootstrap sampling, the primary analysis provided a mean cost difference of -€2282 +/- €27 (CI 95%) and mean effectiveness difference of 0.09 +/- 0.006 averted deaths in favor of Sevelamer. Similar figures were present in the secondary subgroup analysis (-€2403 +/- €28 and 0.15 +/- 0.007). Sevelamer showed a dominance profile in 84% and 90% of all simulations. CONCLUSIONS: The early use of Sevelamer in NDD-CKD patients proved more effective and less costly, generating good value for money from the NHS perspective.