BACKGROUND: Immunosuppresive therapy after organ transplantation is financed from federal budget in Russia, but only when certain drugs are prescribed, i.e. mycophenolic acid, mycophenolate mofetil, cyclosporine, tacrolimus. Everolimus had demonstrated good efficacy and safety in renal transplantation patients but has not been included into federal drug provision program yet. OBJECTIVES: to calculate cost difference between two approaches for immunosuppressive therapy after renal transplantation: everolimus plus reduced-exposure cyclosporine (Ev+Cyc_red) and mycophenolic acid plus standard-exposure cyclosporine (MA+Cyc_st) for Russian healthcare system. METHODS: We calculated the two-year difference in costs that resulted from efficacy and safety differences of compared alternatives employing the probability model. Data on safety and efficacy of compared strategies were taken from D. Cibrik et al. randomized control trial (2013). Direct medical costs were calculated from the Russian healthcare system point of view. We also estimated the 5-year budget impact of everolimus inclusion into the drug provision program financed from federal budget. RESULTS: Ev+Cyc_red leads to cost reduction by €2.5 thousands (17%) per patient in a two-year period when compared to MA+Cyc_st. The reduction mainly results from less costs for immunosuppressive drugs in Ev+Cyc_red approach compared to MA+Cyc_st. Also costs for cytomegalovirus infection prevention and treatment are smaller in  Ev+Cyc_red strategy. Everolimus inclusion into federal drug provision program will lead to reduction in federal budget spending starting from the first year; the total five-year budget savings are €4.3 million. CONCLUSIONS: Ev+Cyc_red is a cost-saving option for immunosuppressive therapy after renal transplantation in Russia when compared with MA+Cyc_st.