PREDICTING THE FUTURE-DEMAND FOR RENAL REPLACEMENT THERAPY IN ENGLANDUSING SIMULATION MODELING

Background. The purpose of the study was to estimate the future demand for renal replacement therapy in England. Simulation modelling was us ed to estimate the future demand, under varying assumptions, about the growth in the acceptance rate for renal replacement therapy, patient and treatment survival, and the availability of kidney transplants. Me thods. Data were obtained from the National Renal Review, the European Dialysis and Transplant Registry, and the United Kingdom Transplant S upport Services Authority. They were analysed to provide transfer and survival data on patients treated for endstage renal failure in Englan d and in four exemplary district health authorities. The simulation ru ns provided estimates of numbers of patients being treated by dialysis and transplantation over the next 15 years. Results. The results indi cated that the number under treatment was predicted to rise by between 50 and 100% over the next 15 years, with a disproportionate increase in dialysis of up to 150%. There will be more 'high-risk elderly' peop le under treatment, particularly amongst the dialysis patients. The gr owth in numbers will vary between districts depending on their level o f need and current service position. Conclusion. There will be increas ing numbers of patients, particularly elderly patients with associated comorbidity, receiving treatment. Given the shortage of kidneys for t ransplantation, the demand will fall on haemodialysis and continuous a mbulatory peritoneal dialysis facilities. Purchasers are thus faced wi th steeply rising costs for this patient group, especially in areas of high need, whilst needing to find improvements in their quality of ca re.