This review focuses on pharmacoeconomic aspects of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD). SHPT characterized by excessive secretion of parathyroid hormone is a severe complication of CKD posing a significant burden on healthcare system. Economic studies demonstrate that target mineral metabolism parameters in these patients reduce treatment costs, including expenses associated with hospitalization and renal replacement therapy. The main treatment approaches for SHPT include dietary therapy, pharmacotherapy, and surgical intervention. Dietary counseling, particularly specialized counseling, is effective in reducing serum phosphorus and lowering costs. Vitamin D analogs, cinacalcet, paricalcitol, and etelcalcetide are the most common among pharmacological treatments of SHPT in CKD. Cinacalcet is effective in several countries, including the U.S. and some European nations, but its use is not always economically justified, for example in China. Paricalcitol demonstrated advantages over other vitamin D analogs, including reduced mortality and lower treatment costs. Surgical treatment (parathyroidectomy) may be more cost-effective in long-term disease management, despite high baseline costs. Social determinants, such as low income and ethnic background, also influence access to treatment and outcomes. For example, patients with lower socioeconomic status are more likely to suffer from vitamin D deficiency and SHPT-related complications. Ethnic groups, such as African Americans, face higher hospitalization costs and lower-quality medical care. At the same time, data on this issue remain limited. Many studies were conducted some time ago, and it is difficult to extrapolate their findings to current practice. Further economic research, particularly in the Russian Federation, is needed to optimize healthcare resource management and improve treatment accessibility for all patient groups.