OBJECTIVES: to demonstrate cost-effectiveness (ICER) of Mimpara (MIM), a drug against secondary hyperparathyroidism (sHPT) in dialysis, compared to standard treatment of care (SOC)METHODS: a Markov model operates in ½ year cycles and runs over 16 years until the starting cohort reaches 70 years. Mortality risk per cycle was calculated from a 2-year cohort dialysis database (n=13,000)1. The model uses specific distributions for parathyroid hormone (PTH), Calcium (Ca) x Phosphor (P), age, vintage and MIM dosages (30-120 mg/day) from phase III trials. Patients withdrawing from MIM were treated with SOC. Average drug costs were € 3,109/year first cycle and € 2,617/year subsequent cycles as only drug responders (85%) remained on study drug. Other treatment costs were taken from a retrospective cost study in Belgium 2 using average daily cost of € 214 per dialysis patient plus € 50/day for sHPT-sufferer. Annual 3% discount rate was applied to cost and outcome data. RESULTS: Running the model in Monte-Carlo simulation (10,000 iterations) over 16 years, delivered a mortality difference of 0.17 years favoring MIM-use for an extra cost of € 8,027 (+ dialysis cost) resulting in an ICER of € 47,218 per Life Year Gained. Excluding dialysis costs the ICER was € 36,970. Sensitivity analyses ranging discount rates from 0% to 6% independently for both outcome and cost data showed ICERs of € 36,970 and € 59,459 for outcome and € 64,517 and € 35,088 for cost results, respectively. Evaluating the ICERs over time indicates that cost-savings may appear early in MIM-treatment (first 2 to 3 years) due to reductions in co-morbidities without observable survival benefit. CONCLUSION: Including dialysis costs in the ICER-equation maintained a reasonable CE-result (