The prevalence of end-stage renal disease continues to increase globally, and most patients are treated with dialysis. Despite technological advances in dialysis care, the relatively high costs of providing dialysis have not decreased substantially over the past 4 decades. These 2 factors are a significant concern in this era of fiscal restraint and finite health care budgets. Economic evaluation of dialysis treatment consistently has shown that home-based hemodialysis and peritoneal dialysis are less costly than in-center hemodialysis. Although only a portion of patients may be eligible for this therapy, current use in Canada and the United States suggests that significantly more patients could be treated with these therapies, which would result in significant cost savings without compromising patient outcomes. There is some evidence to suggest that the modality of home nocturnal dialysis may offer improvements in clinical outcomes including quality of life, but further study of the cost effectiveness of this modality is required.