OBJECTIVES: Annual cost of renal replacement therapy is an important benchmark for public reimbursement of all health care services. The last report was presented more than 10 years ago in Hungary, so our objective was to calculate the current annual cost of waiting listed dialysis and renal transplantation. METHODS: We selected all waiting listed or renal transplanted patients between July 2004 and March 2008. Resource utilisation of all health care services with public reimbursement per patient in Q1 2008 were aggregated by linking claims records with anonimised patient IDs. We calculated health care costs of waiting listed and renal transplanted patients. Results were adjusted to gender, age and onset of ESRD by multivariate regression analysis. A total of 135 HUF/USD GDP specific PPP exchange rate was employed to convert results into USD. 2008 cost calculations were compared to results of the 1997 analysis RESULTS: A total of 2209 patients were selected to the analysis. 3 year cost of waiting listed dialysis and renal transplantation was US$110,742 and US$87,420 respectively. Renal transplantation is cost-saving within 2 years compared to dialysis. CONCLUSIONS: Between 1997 and 2008 the 3-year cost of waiting listed dialysis increased by 60.3%, 3-year cost of renal transplantation increased by 96,8% without correction for inflation. In real values the health care costs waiting listed dialysis and renal transplantation is reduced by 26.7% and 10,0%. During this period the cost-containment measures of the National Health Insurance Fund were successful.