OBJECTIVES: Budget impact (BIM) analysis of the use of paricalcitol versus standard of care (SOC) for the treatment of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) considering paricalcitol treatment start in the pre-dialysis phase. METHODS: Effects and costs deriving from the use of paracalcitol versus SOC for treatment of SHPT in CKD patients were simulated using a Markov models contemplating the natural history of CKD and introducing the use of parcalcitol treatment from the early stage of kidney disease (CKD3) versus SOC considering the use of comparator only from the dialysis stage. A 5-years horizon and the Italian NHS perspective were used. Epidemiologic and clinical data were derived from literature and other assumptions were discussed with clinicians. Both national tariffs and costs from literature were used upon availability and referred to 2012. One-way sensitivity analyses for model inputs were conducted. Costs and effects were discounted at 3% annum. RESULTS: The use of paricalcitol for the treatment of SHPT was cost-saving for the Italian NHS even starting therapy in the early stage of CKD. In a hypothetical cohort of 1,000 patients per treatment group, the overall direct health costs were 10,181,627 Euro for paricalcitol and 10,816,812 Euro for SOC. Both drug-related and others direct costs were lower for paricalcitol resulting in an overall cost-saving of 1,256 Euro per-patient and stemming from a per-patient increase of drug-related costs of 5,126 Euro and a saving of the others direct costs of 6,382 Euro. CONCLUSIONS: Timing paricalcitol treatment from the early stage of CKD could induce a cost-saving for the NHS. Moreover, despite the high acquisition costs for paricalcitol, benefits resulting from an early treatment of SHPT could determine a decrease of the others direct costs exceeding the burden of drug costs.