OBJECTIVES: A recent pilot study suggests the current NHS HRG Tariff for parathyroidectomy (PTX) (£2,710 and £2,209 in patients with and without complications respectively) is not representative of the true costs of surgery in patients with secondary hyperparathyroidism (SHPT). This study aims to describe the healthcare resources used to manage patients undergoing PTX, for SHPT, and estimate the cost in a UK tertiary care centre. METHODS: Resource use was identified by combining data from the PROTON renal database, and routine hospital data, for all adults undergoing PTX for SHPT at Cardiff and Vale University Health Board from 2000-2008. Data were supplemented by a questionnaire completed by clinicians in the Cardiff centre.  Costs were obtained from the NHS reference costs, British National Formulary and published literature. These costs were applied for the following periods: pre-surgical, surgical, peri-surgical, and post-surgical to calculate the total cost of PTX. RESULTS: The analysis included 124 patients (mean age 51.0, SD 13.8). Patients’ underlying renal disease had a wide range of causes, undergoing renal replacement therapy for a mean of 7.3 years, SD 7.0 prior to PTX.  The main costs identified included the surgical stay (average £4,100, SD £2,338; mean stay 5.6 days, SD 7.4), yearly post-discharge outpatient surveillance (£735, £147 and £147, in the first, second and third years respectively) and medications (£733, £650 and £643, in the first, second and third years respectively).  Average total cost for the pre-surgical, surgical, and peri-surgical periods amounted to £4,968 (SD £2,361). CONCLUSIONS: This analysis demonstrates that the cost of PTX surgery in SHPT exceeds the current NHS HRG tariffs for PTX.