**Abstract**

The medical treatment of renal failure is increasingly being discussed in terms of medical economics against the background of disease mechanisms, treatment techniques, and related systems. Particularly, renal replacement therapy requires considerable medical resources and results in high medical costs; therefore, the interest in medical economics is increasing worldwide. This article discusses the cost-effectiveness of renal replacement therapy using macro- and micro-analyses. Based on the macroscopic analysis of international comparisons of renal replacement therapy systems based on medical expenses per patient with end-stage renal disease and a one-year mortality rate, Japan performed better than other developed countries. A clinical economic study of renal replacement therapy is significant because it quantitatively demonstrates the socioeconomic value of life-saving and health benefits (Hemodialysis: approximately 6.5 million JPY/Qaly). In other words, even with high annual medical expenses and a heavy financial burden, the level of medical fees is appropriate from the perspective of the public's value judgment. A microanalysis comparing the cost-effectiveness of marginal and standard donors revealed no statistically significant difference in their cumulative medical costs per long-term life expectancy. Thus, evidence and decision-making related to medical economics are required for the sustainable development of the medical system for end-stage renal disease.

**Keywords:** health economy, medical innovation, cost-effectiveness analysis, renal replacement therapy, kidney transplantation, marginal donor, universal health coverage, international comparison
