OBJECTIVES: Icodextrin-based solutions have potential clinical advantages over glucose-based solutions in fluid and metabolic management of diabetic end state renal disease (ESRD) patients undergoing peritoneal dialysis (PD). The cost-effectiveness (CE) of icodextrin-based solutions compared to glucose-based solutions is not known. The purpose of the present study is to estimate CE of icodextrin-based solution for peritoneal dialysis in diabetic ESRD patients with high average and high peritoneal transport. METHODS: A decision analytic model was developed to estimate cost per life year gained of icodextrin-based solutions. Clinical (improvement in peritoneal ultrafiltration, reduction of extracellular fluid volume, metabolic, blood pressure control, edema, therapy related complications, and mortality) and resource utilization (all-cause hospital admissions and lengths of stay) data were obtained from a 12 month, multicenter, open-label, randomized, clinical trial conducted in the Mexican Institute of Social Security (IMSS) in Mexico City where patients were assigned in one of two groups, dextrose (GLU, n=29) or icodextrin (ICO=30). Cost data, expressed in 2006 US dollar, were obtained from financial information database in IMSS. Costs related to adverse events, drugs, hospitalizations, medical care, intensive care unit and surgery were included. Univariate and probabilistic sensitivity analyses were performed using a Monte Carlo simulation method. RESULTS: Clinical data indicated that icodextrin-based solution was a significant aid for the management of this population. Patients in ICO group had lower hospital length of stay (on average 3 day) compared to GLU group. The total per patient per year cost of ICO group was $13,953, while that for GLU group was $16,788. Expected cost-effectiveness ratios were $14,209 per life year gained and $17,716 per life year gained for ICO and GLU, respectively (p<0.0001). ICO group was also shown to be dominant in 100% of cases. CONCLUSION: Icodextrin-based solution was cost-effective in treating diabetic ESRD patients with high average and high peritoneal transport undergoing PD treatment.