OBJECTIVES: To estimate the cost-effectiveness of remifentanil/propofol versus fentanyl/propofol as regimen of total intravenous anesthesia using infusion pump in Mexican Health Sector. METHODS: An expert panel with anesthesiologists was established to identify the medical and non-medical health resources used to perform a general anesthesia in patients with 65 kg, ASA I (American Society of Anesthesiologists) for a range in the anesthetic time from 60 to 180 minutes and the effectiveness accomplished with the regimens. The information gathered from the expert panel was completed with a literature review. Official unitary costs for the Mexican Institute of Social Security (IMSS) and Hospitals from The Ministry of Health were used. The expected cost per patient included the costs of drugs, post-anesthetic care unit, labor costs and costs associated with adverse events. Costs were expressed in Mexican Pesos and then converted to US dollars (rate exchange 11 Mexican pesos = 1USD). RESULTS: For the remifentanil/propofol regimen the induction doses were 1mcg/kg remifentanil and 2mg/kg propofol; the maintenance doses were 0.5mcg/kg/min remifentanil and 85mcg/kg/min. For the fentanyl/propofol group the induction doses were 3mcg/kg fentanyl and 2mg/kg propofol; the maintenance doses were 3mcg/kg/hour fentanyl and 120mcg/kg/min. For the median of anesthetic time, 120 minutes, the costs per anesthesia were $1,421 (129 USD) and $1,644 (149 USD) for the remifentanil/propofol and fentanyl/propofol regimen, respectively. The average extubation time was 7 minutes for the regimen with remifentanil, and 15 minutes with fentanyl. Using a visual analogue scale, where 0 represents the worst value and 10 the best, the remifentanil/propofol regimen was graded 9.6 and the fentanyl/propofol 8.6. CONCLUSIONS: Regimens with remifentanil/propofol dominates fentanyl/propofol techniques, since they provide a highly effective and secure anesthesia and also represents a significant saving in total resources used (mainly in use of propofol and post-anesthetic care unit) offsetting its higher acquisition costs.