OBJECTIVES: To determine the cost-effectiveness of meropenem treatment versus standard strategy of antibiotic (AB) therapy for high-risk patients with nosocomial infection (NI) in the intensive care unit (ICU). METHODS: Two group high-risk patients with NI were randomly assigned to AB treatment: 1st - 62 pts received meropenem (1.5 - 3 g daily) and 2nd - 73 pts treated by standard AB therapy (combination of penicillins with or without a betalactamase inhibitor, cephalosporins III or IV generation, fluoroquinolons with aminoglicosides). Direct medical costs (cost of drag administration, resource utilization, duration of hospitalization) were estimated. Achievement of recovery was used as effectiveness. Unit costs were based on detailed data from the Moscow Obligatory Insurance Fond (2006). The rate of exchange was 34,44 rubles for 1 EUR. RESULTS: Direct medical costs were 1618.6 EUR for group 1 (C1) and 2065.7 EUR for group 2 (C2). Achievement of recovery - 80.6% (E1) and 46.6% (E2) for each group respectively, p<0,01. The final calculation of cost/ effectiveness ratio (CER) was: CER1 = €20.08 and CER2 = €44.32 per every percent of recovered patients for group 1 and 2 respectively. CONCLUSION: Meropenem usage versus standard AB therapy is more effective from the position "cost-effectiveness" in the treatment of high-risk patients with nosocomial infection in the intensive care unit.