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Background: End-stage renal disease (ESRD) is a debilitating condition resulting in death unless treated. Treatment options include conservative care, transplantation, and dialysis. Major alternative dialysis modalities include peritoneal dialysis (PD) and in-center hemodialysis (ICHD), which have been shown to produce similar outcomes and survival. The need to provide dialysis treatment for patients with ESRD represents a significant financial challenge for global health care systems. Changes in clinically-appropriate dialysis delivery leading to more efficient use of resources would increase health systems’ ability to meet that challenge. The purpose of this paper is to evaluate the economic literature of PD and ICHD within the context of continued economic uncertainty and pressure on healthcare resource use. Methods: A systematic literature search was conducted for studies published between 2004 and 2012. Articles are included if they were original research studies in English which reported costs and/or cost effectiveness associated with PD and ICHD. Results: Twenty-four articles are included in our review, six of which are cost effectiveness studies comparing PD and ICHD. Conclusions: Our findings echo those of prior published reviews, showing that PD is significantly cost-saving compared to ICHD therapy in most developed countries and some developing countries. Increasing the use of clinically-appropriate PD would substantially reduce healthcare costs.