The worldwide incidence of kidney failure is on the rise and treatment is costly; thus, the global burden of illness is growing. Kidney failure patients require either a kidney transplant or dialysis to maintain life. This review focuses on the economics of dialysis. Alternative dialysis modalities are haemodialysis (HD) and peritoneal dialysis (PD). Important economic factors influencing dialysis modality selection include financing, reimbursement and resource availability. In general, where there is little or no facility or physician reimbursement or payment for PD, the share of PD is very low. Regarding resource availability, when centre HD capacity is high, there is an incentive to use that capacity rather than place patients on home dialysis. In certain countries, there is interest in revising the reimbursement structure to favour home-based therapies, including PD and home HD. Modality selection is influenced by employment status, with an association between being employed and PD as the modality choice. Cost drivers differ for PD and HD. PD is driven mainly by variable costs such as solutions and tubing, while HD is driven mainly by fixed costs of facility space and staff. Many cost comparisons of dialysis modalities have been conducted. A key factor to consider in reviewing cost comparisons is the perspective of the analysis because different costs are relevant for different perspectives. In developed countries, HD is generally more expensive than PD to the payer. Additional research is needed in the developing world before conclusive statements may be made regarding the relative costs of HD and PD.

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End-stage renal disease (ESRD) is a debilitating condition Background resulting in death unless treated. Treatment options include conservative care, transplantation, and dialysis. Major alternative dialysis modalities include peritoneal dialysis (PD) and in-center hemodialysis (ICHD), which have been shown to produce similar outcomes and survival. The need to provide dialysis treatment for patients with ESRD represents a significant financial challenge for global health care systems. Changes in clinically-appropriate dialysis delivery leading to more efficient use of resources would increase health systems' ability to meet that challenge. The purpose of this paper is to evaluate the economic literature of PD and ICHD within the context of continued economic uncertainty and pressure on healthcare resource use.A systematic literature search was conducted for studies published Methods: between 2004 and 2012. Articles are included if they were original research studies in English which reported costs and/or cost effectiveness associated with PD and ICHD.Twenty-four articles are included in our review, six of which are cost Results: effectiveness studies comparing PD and ICHD.Our findings echo those of prior published reviews, showing that Conclusions: PD is significantly cost-saving compared to ICHD therapy in most developed countries and some developing countries. Increasing the use of clinically-appropriate PD would substantially reduce healthcare costs.