OBJECTIVES: Currently in Brazil, acromegaly patients who fail having biochemical control with somatostatine analogues face an unmet need. This research aims to assess the economic impact of introducing pegvisomant to treat patients under the public health care system perspective. METHODS: An economic model considering patients treated with Pegvisomant (PtwP) and patients without biochemical control (PWoC) was developed by using the available literature and Brazilian public databases to evaluate the frequency of the following outcomes: Life years gained (LY), quality adjusted life years gained (QALYs), cases of diabetes mellitus (DM), high blood pressure (HBP), myocardial infarctions (MI), joint replacement surgeries (JR) and number of life years without DM, HBP or MI (YWoDHM). The model was composed by a decision tree portion to evaluate “JR” or “no JR” heath states, from which one-year Markov cycles were initiated considering the following health states: No morbidity; DM; HBP; MI; HBP+DM; DM+MI; HBP+MI; HBP+DM+MI; death. Probability inputs would either follow general population data to estimate biochemical control or active acromegaly data to depict treatment failure. The time horizon was defined as 37 years, lifetime for PWoC since diagnose. Probabilistic sensitivity analysis was performed by Monte Carlo simulation using 10.000 iterations. 5% discount rates were applied to costs and benefits. Values were represented in 2010 USD. RESULTS: The values for PtwP versus PWoC were: 152.382 versus 143.935 for LY; 116.201 versus 87.227 for QALYs; 2.738 versus 6.141 for DM cases; 5.247 versus 7.244 for HBP cases; 753 versus 778 for MI cases; 67 versus 327 for JR cases and 219.319 versus149.896 for YWoDHM. ICERs for LY and QALYs were USD305.078,60 and USD89.068,00, respectively. CONCLUSIONS:  Pegvisomant has an important role in reducing premature deaths and morbidities such as DM, HBP, JR and MI to the PWoC under the public heath perspective in Brazil. Real world data is necessary to identify underlying costs for the studied population.