OBJECTIVES: To investigate the 5-year health care budget impact of variable distribution of end-stage renal disease (ESRD) patients treated with peritoneal dialysis (PD) and hemodialysis (HD) in South Korea. METHODS: Budget impact model was developed to estimate the dialysis-related costs from the payers perspective. Analyzed of the national administrative healthcare database data to defined the target population, prevalence, incidence, medical cost. We assumed that specific ESRD patient would choose the PD instead of HD. In the baseline model, among dialysis patients 18% of them were assumed to receive PD and 82% HD in alignment with 2003-2015 national administrative healthcare database data. Eight hypothetical scenarios were compared with this reference scenario. The scenarios were increase in the PD use of prevalence by 6%, 13%, 20%, 50% per year. The other scenarios were increase in the PD use of incidence by 30%, 50%, 70%, 100% per year. RESULTS: There were no differences between HD and PD`s mortality, cardiovascular event in neither diabetic nor over 65 years old. The results showed all scenarios decrease the budget compared to the reference scenario. To examine the validity of this model, various sensitivity analyses were performed. Throughout the sensitivity analysis, the trend of budget impact did not change. CONCLUSIONS: Under the Korean Healthcare system for dialysis, increasing the proportion of patients on PD versus HD could generate substantial savings in dialysis-related costs to the payer. A PD-preferred policy for clinically appropriate patients is also a good strategy to address inequity in dialysis access.