OBJECTIVES:  We compare, through cost-effectiveness and cost-utility analyses, two main components of kidney replacement therapy (KRT): hemodialysis (HD) and peritoneal dialysis (PD) (including under PD both continuous ambulatory peritoneal dialysis [CAPD] and automated peritoneal dialysis [APD]). METHODS:  We used a simple decision-tree model, a third payer perspective with only direct costs included, and a one-year timeline (with no discount). The model incorporated 20 variables, including costs obtained from local sources (databases of more than ten thousand patients) and epidemiological data both from international published literature, and Colombian databases (particularly for treatment-related complications). Utilities (in QALY) were obtained from Tufts CEA Registry and discussed with local experts and patient panels (for an average of 0.6375 QALY for PD and 0.5950 for HD). RESULTS:  We estimate that the average annual cost of PD in Colombia in 2008 was US$16,747 (at September 2009 official exchange rate of Col$2066 per dollar) while HD costs on average US$18,199 per year, including in both cases direct costs of treatment-related complications but not other disease-related events. Average cost of each QALY gained in a dialysis patient in Colombia ranges from US$26,300 in PD to US$30,600 in HD. In our sample, PD was also associated with a reduced frequency of hospitalization and shorter hospital stays than HD (on average, 5.2 and 6.5 hospital days per year, respectively). CONCLUSIONS:  In Colombia, costs of KRT are around two times the suggested cost-effectiveness threshold of three times the per capita GDP. On average, and perhaps in part attributable to different case mix, PD is dominant over HD. The model is highly sensitive to patients preferences (expressed in our case in QALYs), which suggest PD is particularly valued in independence seeking patients.