OBJECTIVES To estimate the resource use and direct medical costs associated with acromegaly treatment under the Brazilian public health care system (BPS) perspective. METHODS Expert opinion was used because neither the published literature nor national databases contain adequate information on the resource use and costs associated with acromegaly in Brazil. The role of the expert panel was two-fold: to validate the acromegaly treatment algorithm and estimate the resource use associated with treatment. The panel was comprised of four endocrinologists, considered experts in the field and who work in the BPS. Only direct medical costs were considered in the analysis, including medications, outpatient visits, surgery, radiation therapy and acromegaly-related tests and procedures. Unit costs were obtained from BPS databases. RESULTS The estimated distribution of patients between health states was 33% for adequately controlled disease, 34% uncontrolled disease despite drug therapy, 8% uncontrolled disease without drug therapy and 24% cure. The mean estimated cost per patient with adequately controlled acromegaly in 5 years was R$135,039 (US$96,457; 2005 PPP index 1USD = 1.4BRL). Among patients with uncontrolled disease, those undergoing drug therapy represent a mean 5-year cost per patient of R$135,989 (US$97,135) and the mean cost associated with patients without drug therapy was R$6684 (US$4775). For cured patients, costs were incurred only for treatment of adenoma and exams in the first year, corresponding to total costs of R$4292 (US$ 3066). Medications were the largest contributor to overall cost, corresponding to 81% of total costs. The chronic complications of long-standing disease increase costs significatively, but were not included in the analysis, contributing to the absence of significant cost differences between controlled and uncontrolled patients. CONCLUSIONS Patients with acromegaly represent an average cost of R$93,069 in 5 years to the public health care system, considering a weighted average of patients in all possible health states.