OBJECTIVES: This HTA aims to investigate the disease burden of ESRD, and assess the clinical and economic impact of Home based Hemodialysis (HD) compared to Hospital based Hemodialysis (HD) to further the reach of dialysis services amongst patient with Renal Failure.  METHODS: Health technology assessment by systematic review of published literature. An electronic literature search was performed in Cochrane, PubMed, British Medical Journal, Kidney International, and Journal of the American Society of nephrology databases for randomized controlled trials that compared, Home Haemodialysis & Hospital Haemodialysis. RevMan 5.3 was used for data analysis and quantitative data synthesis.  RESULTS: Out of 221 studies which were screened, 6 studies involving a total of 16,248 participants (3,465 received Home Haemodialysis, 12,783 receive Hospital Haemodialysis) were found to be suitable & were included. In comparison with Hospital Haemodialysis, Home Haemodialysis significantly reduced mortality: Risk Ratio (RR) 0.65 (95%CI, 0.61 to 0.69). Evaluation of current infrastructure shows that there is shortage of Hospital based Haemodialysis services by 51.92%. With the cost of Home based Haemodialysis as INR 18,000 (US$ 291.47) per month in India, cost of INR 56,854 (US$ 923.33) per QALY gained would be incurred with extremely cost-effective intervention for India.  CONCLUSIONS: Home based Haemodialysis is clinically and economically effective in reducing the mortality of patient with ESRD. Given the high burden of disease there is an urgent need for expanding the reach of for Home based Haemodialysis care.