OBJECTIVES: Dialysis treatments are performed in 4100 patients in Serbia. At end-stage renal disease (ESRD)the only correct selection is kidney transplatation. The basic aim of research was to compare ratio of costs and effects (CEA) of hemodialysis and kidney transplatation in patients at ESRD.It is assumed, that in spite of that kidney transplatation is being more desirable than hemodialysis from aspect of lower costs and better quality of patient's life, number of transplantations in Serbia is still modest with respect to requirements. METHODS: The life quality was measured by validated McGill Questionary. Research has included 150 patients totally, divided in two groups: 1) Study group including 50 patients having kidney transplantation performed at Clinical Centre of Serbia; and 2) Control Group including 100 patients on hemodialysis at six different Clinical Centres , comparable with respect to sex, age and length of treatment with Study group. RESULTS: Effect of kidney transplantation in relation to hemodialysis being selection of treatment is expressed in form of incremental ratio of costs and effects (ICER). It is clearly evident that the strategy of kidney transplantation is far more profitable considering the fact that it represents saving of €132,256.25 per one year of contribution QALY within the period of 10 years. According to all aspects of live quality (physical symptoms and problems, physical well-being, phychological symptoms, existential well-being and support), difference is statistically important in favour of transplant patents. CONCLUSIONS: Out of the effected cost calculation it is evident that the costs of patient treatment therapy by hemodialysis at end-stage renal disease is far greater than by performing therapy of transplantation and maintenance, by almost three and a half times (3.38). Difference in total aspects of human life (physical, emotional, social, spiritual and financial) between dialysed and transplant patients is statistically important and by 18.12% greater in transplant patients than in patients being on hemodialysis.