OBJECTIVE: To assess the economic impact of everolimus 1.5mg with reduced-dose cyclosporine (CsA) vs. mycophenolate motefil (MMF2g) with full dose CsA in de novo renal transplant recipients. METHODS: A previous trial (B201) which prospectively collected resource utilization during one-year showed similar economic outcomes for everolimus vs. MMF2g with full-dose CsA. Direct medical costs (excluding everolimus, CsA and MMF) were mostly dependent on key clinical events: hemodialysis, length of stay (LOS) due to adverse events (AE) or infection (INF), biopsy proven acute rejection (BPAR) and days on cytomegalovirus (CMV) therapy. A subsequent trial of everolimus with reduced-dose CsA demonstrated similar efficacy (A2306). A multivariate model was fitted on the B201 data to predict direct medical costs. Coefficients were then applied to the A2306 data to predict the economic outcomes of everolimus with reduced-dose CsA. As no significant country-specific cost effect on LOS was found, individual country cost vectors were applied (Germany, France and Spain). RESULTS: For Germany, incremental costs were 250€ per hemodialysis session (p<0.001), 261€ per day of hospitalization due to AE (p<0.001), 343€ per day of hospitalization due to INF (p<0.001) and 4473€ per BPAR (p<0.001). After adjusting for recipient age, living donors, and CMV therapy between B201 and A2306, everolimus with reduced-dose CsA decreased 1-year costs by 3260€ vs. MMF with full-dose CsA. Taking into account cost of CsA, MMF and everolimus (assuming parity pricing of everolimus 1.5mg and MMF 2g), everolimus with reduced-dose CsA decreased total 1-year costs in Germany by 3960€. In Spain and France, the final cost-savings would be 1516€ and 3217€, respectively. CONCLUSION: In de novo kidney transplant recipients over a 1-year follow-up period, everolimus 1.5mg with reduced-dose CsA is a cost-saving strategy compared to MMF-based regimen. Further analyses in other health care settings are needed to fully document the cost-saving of everolimus 1.5mg.