OBJECTIVES: The purpose of this study was to analyze the cost-effectiveness of the association of everolimus (EVR) with reduced tacrolimus doses (rTAC) in liver transplantation patients with renal dysfunction. METHODS: A cost-effectiveness analysis was conduced from the National Public Health System (SUS) perspective.  A Markov model was constructed using TreeAge Software to simulate the clinical of patients that undergo to liver transplantation, with 10 years of horizontal time. In the model, the expected cost and effectiveness were compared between EVR+rTAC versus TAC. In both treatment strategies, there were the possibilities of rejection, graft loss, renal failure and renal transplantation and death. The probabilities were taken from a multicenter clinical randomized study that followed the patients for 2 years after liver transplantation using TAC or EVR+rTAC. The chosen endpoints were rejection, graft loss and renal dysfunction (creatinine clearance<60, MDRD4, mL/min/1.73m). The estimative of 525 patients that will need a liver transplantation at SUS per year was used in Monte Carlo microssimulation, based on 2014 data. RESULTS: EVR+rTAC strategy preserved 26.2% of renal function, decreased 7.2% of rejections, avoided 1.9% of renal transplantation and 7.8% of liver re-transplantation. The treatment with EVR+rTAC increased the annual public costs in $172.78 (the first year) and $361.08 (the first two years) per patient. The simulation of EVR+rTAC only in patient who will have renal dysfunction after liver transplantation resulted in an annual median cost of $251.02 per patient per complication avoided, 37% less than when all patients used TAC ($1,312.32). The Monte Carlo microsimulation for 525 potential patients resulted in a cost of $1,072.51 per year per patient free of complications treated with EVR+rTAC, 18% less than when all patients were treated with TAC. CONCLUSIONS: Everolimus associated with reduced tacrolimus doses is cost-effective when analyzing the renal dysfunction avoided in the liver transplantation.