OBJECTIVES::  Nivolumab demonstrated a significant survival benefit when compared with everolimus (median OS 25.0 vs 19.6 months; hazard ratio: 0.73, P=0.002) in a randomized Phase III trial conducted in patients with advanced renal cell carcinoma (aRCC) who had received previous anti-angiogenic treatment. Similarly, a substantially higher objective response rates favouring patients receiving nivolumab (25.1% vs 5.4%; odds ratio: 5.98, P<0.001) was observed in this trial. The aim of this analysis was to compare the monthly cost per responder with nivolumab versus everolimus in the Brazilian private healthcare system perspective. METHODS::  This analysis was based on investigator-based patient-level data from a randomized phase III trial. ORR was defined as the proportion of patients who achieved a partial or complete response. Costs were calculated based on drug, administration, and managing of grade 1-4 treatment related adverse events (TRAEs) reported on Checkmate 025. Drug costs for nivolumab and everolimus were obtained from the official Brazilian price list (Feb/2017) by CMED. The management of TRAEs was obtained through a Delphi panel, followed by microcosting of resources obtained from public sources (Kairos and Simpro Magazine n105/2016 for drugs and materials, CBHPM 2016 for medical appointments and procedures, and UNIDAS National Research 2015 for hospitalizations). Monthly cost per objective response was calculated by dividing the average monthly cost per patient by ORR. RESULTS:: Median duration of treatment was 5.5 months for nivolumab and 3.7 months for everolimus. Monthly cost per patient was R$ 37.764 for nivolumab and R$12.886 for everolimus. Monthly cost per responder was R$ 90.419 lower for nivolumab versus everolimus (R$ 150.322 vs R$ 240.741). CONCLUSIONS:: The present analysis suggests that in the face of nivolumab’s substantial clinical benefits on OS and ORR treatment with this agent can result in significant reductions in health care costs to achieve one responder compared to everolimus.