OBJECTIVES: To conduct a cost-effectiveness analysis (CEA) study of sevelamer versus calcium based binders (CBBs) in treating hyperphosphatemia among patients with end-stage renal disease (ESRD) in China. METHODS: A decision-analytic model of a lifetime horizon was used for base case analysis in the CEA from the payers’ perspective. The overall survival of CBBs was derived from the Dialysis Clinical Outcomes Revisited study for up to 44 months from 2001 to 2004 and a Weibull regression model was used to extrapolate the overall survival to a lifetime horizon. A hazard ratio (HR) (0.54, 95%CI: 0.32-0.93) of the overall survival for sevelamer versus CBBs was used to calculate the survival of sevelamer group. Clinical data, drug acquisition costs and hospitalization costs were derived from literature and healthcare system in the local setting. One-way and probabilistic sensitivity analysis were conducted to assess the uncertainty of the model assumptions and parameters. The results were reported in Chinese Renminbi (RMB). RESULTS: The total per-patient costs were higher for sevelamer than CBBs, resulting in an incremental total cost of ¥57,910. Compared with CBBs, sevelamer treatment also had resulted in a gain of 2.6863 life years (LYs) and 2.0631 quality-adjusted life years (QALYs). The incremental cost per LY gained and per QALY gained was ¥44,475 and ¥57,910, respectively. The incremental cost per QALY gained was below the WHO’s recommended cost-effectiveness threshold (¥151,070) which is 3x GDP per capita of 2015 in China. The incremental cost-effectiveness ratio was most sensitive to the HR of overall survival of sevelamer versus CBBs in the one-way sensitivity analysis. The cost-effectiveness acceptability curve indicated that sevelamer had an 89.6% likelihood of cost-effectiveness at the ¥151,070 threshold.  CONCLUSIONS: Sevelamer is likely to be a cost-effective option in treating hyperphosphatemia among patients with ESRD compared with CBBs in the local context of China.