OBJECTIVES:: To assess the cost-effectiveness of tacrolimus extended release (tXL) compared to generic tacrolimus (gxT) in the public sector in Mexico. METHODS:: A cost-effectiveness analysis of overall survival after kidney transplantation was developed. According to Hariharan variation in serum creatinine predicts long-term renal graft-survival. Weibull survival functions based on this study were calculated to predict the risk of renal graft rejection. Five years of median overall survival were assumed when patients started dialysis. The difference in adherence between both products was obtained from Kuypers, who reported adherence of 88% for tXL vs. 79% for gxT. The outcome calculation was based on Borra 2010, who published that patients with high-variability of tacrolimus levels have shorter graft survival. A Markov-model was developed with five health states: graft survival, peritoneal-dialysis, hemodialysis, re-transplantation, and death. Three Mexican clinicians were interviewed to quantify the use of resources, treatment patterns and graft survival relative risk ratios between both comparators. The analysis was performed with a 5% discount for costs and effectiveness with a 20-year time horizon. A 40% discount was applied to tXL from the third year of analysis assuming LOE. Actual costs were obtained from the Social Security Mexican Institute and results are presented in USD. RESULTS::  Clinicians interviews with data from over 300 patients, showed that high variability of tacrolimus serum levels was lower in patients with tXL=10% vs. gxT=38% and that variation in creatinine is lower in patients with tXL=13% vs. gxT=25%. This information driven better outcomes in terms of life-year-gained for patients with tXL=9.26 vs. gxT=8.26. Average cost calculated for graft rejection was $4,516 and $2,138 for graft failure. The cost-effectiveness results shown ICER of $22,040 due to avoided or delayed RRT. CONCLUSIONS:: Tacrolimus XL could be a valuable and cost-effective adjunct for kidney transplantation in the public healthcare sector in Mexico.