OBJECTIVES: Sucroferric oxyhydroxide (SFOH) is a novel non calcium, iron based phosphate binder indicated for the control of serum phosphorus (sPhos) levels in adult chronic kidney disease (CKD) patients on hemodialysis (HD) or peritoneal dialysis (PD). A retrospective database analysis of SFOH among in-center HD patients who switched from sevelamer carbonate (SEV) to SFOH, showed that, after 6 months, patients switching from SEV with in-range sPhos (3.5-5.5 mg/dl) increased from 14.1% to 27.9% (98% increase) whilst pill burden decreased from 10.1 pills with SEV to 3.9 pills with SFOH suggesting lower cost per patient responding with SFOH. The objective of this study was to assess and compare the 6-monhtly cost per responder for SFOH versus SEV in Europe. METHODS: Acquisition costs per pill of SFOH and SEV were estimated based on official list prices, weighted for local market shares. Treatment costs were estimated based on the observed daily pill intake, obtained from the retrospective data analysis. Number needed to treat (NNT) to achieve in-range sPhos (3.5-5.5 mg/dl) were estimated and subsequently the 6-monthly costs per responder were estimated for SFOH and SEV. RESULTS: The estimated NNT was 3.6 and 7 for SFOH and SEV, respectively. SFOH consistently attained in-range sPhos (3.5-5.5 mg/dl) at a lower 6-monthly cost per patient compared to SEV. The 6-monthly cost per responder for SFOH and (SEV) were: Austria: €4,511 (€23,319); France: €3,699 (€13,416); Germany: €4,194 (€17,279); Italy: €4,755 (€14,054); Spain: €3,503 (€15,307); UK €6,355 (€25,381); Switzerland: €7,612 (€25,258). SFOH appeared to attain in-range sPhos (3.5-5.5 mg/dl) with considerable 6-monthly cost-savings per patient responding ranging from €9,299 (Italy) to €19, 026 (UK). CONCLUSIONS: SFOH appears to have a favorable NNT and to attain the clinical target of in-range sPhos at a lower cost compared to SEV suggesting favorable cost-effectiveness.