OBJECTIVES: Secondary Hyperparathyroidism (SHPT) is a common complication of chronic kidney disease. Abnormal  levels of Parathyroid Hormone (PTH), Calcium (Ca) and Phosphorus (P) are associated with an increased risk of cardiovascular death and fracture. The aim of the study was to assess the cost per successful response with standard treatment (ST)+Cinacalcet vs. ST alone (vitamin D sterols and chelated phosphates) in patients with SHPT in Mexico. METHODS: A decision analytic model was developed to calculate and compare the costs per successful response with Cinacalcet in adult patients with SHPT to whom a specific scheme of ST has been prescribed. The successful response was defined as the balance (normal levels) in all target parameters: PTH, Ca, P and Ca x P. ST was defined as one of the following combinations: Paricalcitol IV + Chelated Phosphate (PCP), Chelated Phosphate + Calcitriol (CPC) and Paricalcitol  + Calcium Carbonate (PCC). Unit costs were gathered from the 2010 Official Price List of the Public Healthcare System in Mexico. RESULTS: According to the literature, 16% of patients achieve the targets in all parameters when ST is given. The addition of Cinacalcet increases this proportion up to 60%. Considering PCP as the ST, the cost per response was MXP$32,750 vs MXP$16,945 with Cinacalcet+PCP; CPC showed a cost per response of MXP$22,156 vs MXP$15,509 with Cinacalcet+CPC; finally, PCC reflected a cost per response of MXP$14,850 vs. MXP$12,091 with Cinacalcet+PCC. CONCLUSIONS: The addition of Cinacalcet to any ST combination represents a strategy which results to  lower cost per responder principally due to two factors: the reduction of 50% in ST concomitant drugs and the higher response rates in achieving targets for all biochemical parameters.