OBJECTIVES: this study is a cost-effectiveness analysis of immunosuppressive maintenance therapy after renal transplantation in Brazil. The aimed of this study was re-evaluating a possible impact on clinical decisions because of the new policy of pricing and access of tacrolimus due to the loss of patent. METHODS: a hypothetical cohort of 20 years to adult renal transplant patients in maintenance therapy was constructed using the Markov model. All regimens tested, as follows, contains prednisone: cyclosporine+azathioprine, cyclosporin+mycophenolate mofetil, cyclosporine+mycophenolate sodium, cyclosporin+sirolimus, everolimus+cyclosporine, tacrolimus+azathioprine, tacrolimus+mycophenolate mofetil, tacrolimus+mycophenolate sodium, sirolimus+tacrolimus, sirolimus+mycophenolate mofetil. The efficacy estimates were obtained from the literature. The average price of drugs was based on the price list of Brazilian Regulatory Pharmaceutical Market Chamber, relative to October 2012. The costs of the disease stage were taken from literature. The cost was expressed in dollars (U$) and these values were converted using the purchasing power parity factor of 1.81. The effectiveness was measured in life years gained (LY) and adopted the public health system perspective. Sensitivity analyzes were performed. RESULTS: even with a reduction equivalent to 53.5% of the price of tacrolimus, and considering the analysis with 5% discount in cost and effect established in the Brazilian guidelines for assessing technology, all the schemes were dominated by cyclosporine+azathioprine+prednisone. In other analyzes, the scheme tacrolimus+azathioprine + prednisone was not dominated, but the Incremental Cost-Effectiveness Ratio of these two schemes was U$ 86,592.30 / LY in the analysis without discount. This ratio is higher than the Brazilian reference value of three times GDP per capita, used for embedding. No qualitative change was demonstrated by sensitivity analysis and the likelihood of the scheme cyclosporine+azathioprine+prednisone be the most cost-effective is greater than 85%. CONCLUSIONS: In brazilian context, cyclosporine remains more cost-effective for maintenance treatment of kidney transplant, even after the price of tacrolimus having reduced.