OBJECTIVES: The worldwide incidence of kidney failure continues to rise and treatment is costly; therefore, the burden of illness, including the healthcare resources allocated to its treatment, is growing. Given that the number of end-stage renal disease (ESRD) patients is increasing and the majority is on some form of dialysis, the number of dialysis patients is expected to increase as well. The purpose of this assessment was to review published economic evaluations of dialysis treatment modalities, including hemodialysis (HD) and peritoneal dialysis (PD). METHODS: We conducted a systematic literature review of original research articles comparing PD and HD (or their subtypes) in both PubMed and EMBASE for the years 1996 to 2006. Articles were included if they 1) came under the major subject headings of “renal replacement therapy/economics,” or “dialysis/economics,” or “renal dialysis/economics,” or “hemodialysis units, hospital/economics,” or “kidney failure, chronic/economics”, and 2) contained the term “peritoneal dialysis” and either the term “hemodialysis” or “haemodialysis”. Pre-defined exclusion criteria were also applied. RESULTS: Twenty-five articles were included in the formal literature review. The majority of articles were cost evaluations, rather than full economic evaluations of both costs and outcomes. The results show that, in developed nations, HD is generally more expensive than PD to the payer. Research is more limited in developing and emerging countries. Due to inexpensive labor and high imported equipment and solution costs, PD is perceived to be more expensive than HD; however, the costs of dialysis differ by region and additional research is needed in the developing world. CONCLUSION: HD is a more expensive dialysis modality in developed regions of the world. Research in the developing world is too limited to draw definitive conclusions.