OBJECTIVES: End stage renal disease (ESRD) is a debilitating condition resulting in death unless treated. Data show that two available therapies, peritoneal-dialysis (PD) and hemodialysis (HD) have similar survival rates. However, annual average reimbursements per patient are €18,400 for HD and €12,700 for PD. Approximately 18% of treated population used PD. The study estimated the government budget impact of higher PD reimbursement and the resulting increase in PD utilization. METHODS: A budget impact model applied a patient-years-at-risk approach that incorporated point prevalent dialysis patients, current treatment modality distribution, including two PD modalities (automated-peritoneal-dialysis or APD and continuous-ambulatory-peritoneal-dialysis or CAPD), reimbursements by modality, annual dialysis population growth rate, and hypothetical new modality distribution rates. At baseline (2006), Romania had 7060 treated ESRD patients, patient-years-at-risk was set to 0.72, and it was assumed that new dialysis modality distribution would reach by year 3. The model allowed various sensitivity analyses. RESULTS: If PD utilization increased to 25% without any reimbursement increase for PD, 5-year savings was estimated to be €13million. If APD was reimbursed by an additional €1,300 per patient, 5-year savings increased to €18million, assuming overall PD utilization increased to 30% and APD share of PD increased from 4.5% to 30%. If APD reimbursement increased an additional €2,300 per patient and APD share of PD increased to 50%, it would require 35% of all PD patients undergoing dialysis treatment to achieve €18million savings. Finally, at this level of additional APD reimbursement, 5-year savings increase to €25million as PD utilization increases to 40%. With €25million in savings, an additional 1478 patient-years of treatment could be provided in Romania. CONCLUSION: With additional reimbursement for PD and the resulting increase in PD utilization, there is an opportunity for government to lower the total dialysis budget. Government can apply the savings to treat additional ESRD patients.