OBJECTIVES: Secondary hyperparathyroidism (SHPT) is a common side effect of end-stage renal disease and is associated with increased risk of fracture and cardiovascular events. Cinacalcet is the first of a new class of calcimimetic drugs, which suppress parathyroid hormone (PTH) production. The aim of this study is to estimate the cost-utility of cinacalcet in patients with SHPT. Although there is convincing evidence of the positive impact of cinacalcet on serum biomarkers such as PTH, the long-term cost and clinical implications of treatment are less clear. METHODS: A Markov model was developed in Excel to estimate differences in quality adjusted life years (QALYs) in people with SHPT in end stage renal disease (ESRD) treated with cinacalcet, compared to those receiving standard treatment alone. The model was stratified by degree of disease progression. Estimates of the effectiveness of cinacalcet were taken from a systematic review of the literature by the authors. Where possible, other transition probabilities, costs and utilities all came from published sources. Costs and benefits were discounted at 3.5% annually. The perspective of the UK National Health Service was taken throughout. Extensive one-way and probabilistic sensitivity analyses were performed. RESULTS: Compared to standard treatment, cinacalcet incurs average additional lifetime costs of £21,167 per person and confers an additional 0.34 quality adjusted life years, resulting in an incremental cost-effectiveness ratio of £61,890/QALY. This figure is beyond current UK willingness-to-pay thresholds.. Probabilistic sensitivity analysis showed that at a threshold of £30,000/QALY there was only a 0.5% probability that cinacalcet could be considered cost-effective. CONCLUSION: Cinacalcet can reduce levels of serum biomarkers in the treatment for people with SHPT, however our model suggest that the long term clinical impact of this is small. Unless drug costs are considerably reduced, it is unlikely to be considered cost-effective in the UK setting.