Cost of home hemodialysis training was compared with that of continuing hemodialysis at a satellite medical center. The "payback period" was defined as the time after which higher home training and start-up charges equaled and were surpassed by the initially lower satellite charges. This period was 14.4 months. Total cost of home hemodialysis training and start-up at our institution was $15,149.32. Ambulatory medical center hemodialysis during the same period (3 1/2 months) was $6,853.58. Initially, therefore, the cost of home dialysis is $8,295.74 more. However, after 14.4 months, there is an equalization point subsequent to which home hemodialysis costs $7,472.40 less each year. For a subgroup of patients, those with malignant and severe systemic diseases with reduced survival with hemodialysis, home hemodialysis has no economic advantage.