OBJECTIVES: The chronic kidney disease (CKD) is associated with an abnormally elevated level of phosphate in the blood, 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 in Brazil METHODS: A Markov model was created to estimate the monthly 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 (months). Only direct costs were considered . Costs were calculated using 2009 prices and are expressed in US dollars. In addition,  univariate sensitivity analysis and scenario changes were performed. The discount  rate was 5%. RESULTS: The expected cost was US$37,477 for calcium and US$58,397 for sevelamer. Patients in calcium group  would survive 51 months,  compared to the sevelamer  group (54 months). The Cost-Effectiveness Ratio with calcium was  $734  and with sevelamer was $1073 respectively, and the incremental Cost-Effectiveness Ratio for the implementation of sevelamer vs. calcium was $6135 .(1 USD= 1.8 BRL$) CONCLUSIONS: Sevelamer is a cost-effective drug for the treatment of hyperphosphatemia in patients with CKD in the brazilian context.