OBJECTIVES: To evaluate short-term (12 months) cost-effectiveness (CE) of intravenous (iv) vitamin D preparations (paricalcitol and calcitriol) to control hyperparathyroidism in hemodialysis patients. METHODS: A decision analytic model was constructed and analysed from the hospital and the Italian National Health System (INHS) perspectives. Following the indications of the Italian Nephrology Society on the use of iv Vitamin D analogues, patients were simulated to start a 12-month iv Vitamin D treatment when parathormone (PTH) plasmatic level was > 700 pg/ml. Starting doses were 27 μg/week for paricalcitol and 9 μg/week for calcitriol; subsequent maintanance dose was adjusted assuming decreasing PTH levels over time. Model parameters were derived from multiple published sources. Clinical course of treatment and efficacy in controlling hyperparathyroidism were based on a RCT (Sprague SM. Kidney Int 2003); effect on survival, hospitalisation rate and length-of-stay (LOS) were based on retrospective studies (Teng M. NEJM 2003; Dobrez DG. Nephrol Dial Transplant 2004). Cost included drug costs (hospital prices excluding taxes), cost per hospitalization (national mean DRG value, 2002), in the INHS perspective, or cost per day of hospitalization (general medical ward, Lucioni C. et al. Treat Endocrinol 2003), in the hospital perspective. RESULTS: Per patient one-year drug acquisition costs were €3364.74 for paricalcitol and 1883.25 for calcitriol. Calcitriol patients had an average of 0,846 hospitalizations/year more than paricalcitol at an incremental cost, in the INHS perspective (DRG tariffs), of €2868.69. Calcitriol patients had an average of 9.17 hospitalization/days more than paricalcitol at an incremental cost, in the hospital perspective (LOS), of €2249.58. Paricalcitol strategy resulted dominant in both perspectives. Robustness of these findings was demonstrated in multiple sensitivity analyses. CONCLUSIONS: In Italy, paricalcitol greater acquisition costs are offset by reduction in hospitalizations and LOS both from an NHS perspective and from the hospital perspective.