OBJECTIVES: The treatment of secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) is generating high costs worldwide mainly due to adverse complications. In Ecuador, only few healthcare institutions have implemented management protocols for the treatment of SHPT to reduce costs and to improve patient quality of life. The goal of this study was to evaluate the short (1 year) and long-term (5 years) costs and savings in the management of SHPT with calcitriol and paricalcitol in CKD patients. METHODS: Costs of hospitalization, erythropoietin (EPO) and intravenous iron were calculated for 354 CKD patients treated for SHPT in the Carlos Andrade Marín Hospital. The study used international models and standard doses of calcitriol and paricalcitol for a prospective estimation based on the initial parathormone level (PTHi). The costs of services were based on the Ecuadorian National Reference costs (2014) and adjusted for inflation according to official references. Univariate statistical sensitivity analysis was performed. RESULTS: Of the 354 patients, 147 (41.4%) had a PTHi in the range 300-600, 45 (12.8%) in the range 601-800, and 162 (45.7%) above 800 pg/ml. The 1-year estimated costs per patient were: calcitriol US$63.88 and paricalcitol US$926.55; EPO: calcitriol US$19,522.95 and paricalcitol US$16,478; intravenous iron with calcitriol US$143.21 and with paricalcitol US$187.76. During hospitalization, patients consumed US$1,738.51 with calcitriol and US$1,196.93 with paricalcitol. Total costs per patient amounted US$21,468.54 with calcitriol and US$18,790.13 with paricalcitol. Total savings using paricalcitol instead of calcitriol was US$2,674.31. Adjusting for inflation, the 5-year cumulative costs were US$319 for calcitriol and US$1,978 for paricalcitol; EPO with calcitriol US$97,615 and with paricalcitol US$82,394; intravenous iron with calcitriol US$716 and with paricalcitol US$939. Hospitalization costs reached US$9,343 with calcitriol and US$6,432 with paricalcitol. Total savings using paricalcitol instead of calcitriol amounted US$16,249 per patient. CONCLUSIONS: Paricalcitol is less costly than calcitriol in treating CKD-SHPT patients.