OBJECTIVES: To assess the cost-effectiveness of paricalcitrol IV in the management of eligible hemodialysis (HD) patients with secondary hyperparathyroidism (SHPT), in comparison with standard oral vitamin D treatment. METHODS: A decision tree model was used to estimate the cost-effectiveness of paricalcitrol IV for HD patients with increased serum PTH levels despite standard treatment (K/DOQI guidelines). The primary perspective of the study was that of the Dutch society in 2005. Costs and clinical outcomes were discounted at 4%. The data sources included published literature, paricalcitrol IV clinical trials, official price/tariff lists and national population statistics. RESULTS: The base case analysis from the society perspective shows that paricalcitrol IV generates cost savings of €1714 per patient over three years compared to standard oral vitamin D treatment (€27,817 vs. €29,531). Paricalcitrol IV also saves 0.10 Life Years (2.37 vs. 2.27) and leads to a gain in 0.08 QALYs (1.07 vs. 0.99). When the analysis is performed from the health insurance perspective, the total cost savings reduce from €1,714 to €983, but paricalcitrol IV remains dominant over standard oral vitamin D treatment. Potential savings in the paricalcitrol IV treatment arm are to be contributed to a reduction of hospitalization. Gain in utilities is to be contributed to a decreased hospitalization rate and increased survival of the paricalcitrol IV treated population Sensitivity analysis showed that the outcomes were only moderately sensitive to the changes in input variables for the model, but paricalcitrol IV remained dominant in all analyses. CONCLUSION: This study showed that paricalcitrol IV is a cost-saving option in the treatment of HD patients presenting SHPT in comparison to standard oral vitamin D treatment in The Netherlands. Introduction of paricalcitrol IV to the Dutch reimbursement system would propagate costs savings and a gain in life years as well as QALYs.