An economic evaluation was undertaken alongside a multicentre, international, trial of everolimus (Certican). Resource usage within the trial was assessed, and the cost implications of the use of everolimus were evaluated. Recipients of a primary cadaveric kidney transplant were recruited into a double-blind trial and received either everolimus 1.5 mg (n=194); everolimus 3 mg (n=198) or mycophenolate mofetil (MMF) 2 g (n=196). Clinical outcomes and resource usage were monitored for 12 months following transplantation. Local costs were obtained, and global analysis using health sector PPP rates was undertaken. The mean overall cost of treatment was 33,715 dollars (95%CI 30,013 dollars-37,417 dollars) with everolimus 1.5 mg, 38,519 dollars (95%CI 34,094 dollars-42,943 dollars) with everolimus 3 mg and 36,509 dollars (95%CI 32,430 dollars-40,587 dollars) with MMF. Differences between the three groups did not reach statistical significance. In conclusion, the economic analysis showed statistical equivalence over the three arms of the trial. Further work is required to demonstrate the cost consequences of the use of everolimus compared with MMF in renal transplantation patients.