BACKGROUND Contrast-induced nephropathy (CIN) is a clinically significant and costly complication related to the use of iodine-based contrast media (CM). The hypothesis regarding the advantages of isoosmolar CM compared to low-osmolar CM was not confirmed in recent meta-analyses; still, there may be safety differences between individual CM. OBJECTIVES: To perform a pharmacoeconomic comparison of the CM ioversol and iohexol used for x-ray procedures in Russia METHODS: We calculated the costs for using ioversol and iohexol taking into account the risk of the occurrence of CIN and CIN-associated complications. Data for the model were extracted from published clinical trials and reviews. We performed an indirect comparison of both CM to calculate the relative risk (RR) of CIN (via the CM iodixanol as a mutual control). This RR value was used in the model to simulate the impact of potential safety differences between both CM on the costs. Direct medical costs were calculated based on the Russian healthcare system setting. Related costs for CM and for CIN-associated complications (e.g. cardiovascular complications, respiratory distress syndrome and hemodialysis for acute kidney injury) were also taken into account. Cost calculations were performed separately for patients with low, medium and high risk for CIN. One-way sensitivity analysis was performed. RESULTS: RR of CIN was 0.26 (95% confidence interval 0.12-0.58) for ioversol vs iohexol in the indirect comparison. Direct medical costs were higher for iohexol than for ioversol due to the slightly higher rate of CIN, thus, CIN-associated complications: net benefits were 469.16; 752.88 and 3313.13 rubles (~11.03; 17.70; 77.91 Euros) per patient with low, medium and high risk of CIN correspondingly. Still, results were sensitive to the price of both CM.  CONCLUSIONS: In the Russian healthcare setting, the use of ioversol seems to be more cost efficient than iohexol due to slightly favorable renal safety.