Predicting the future demand for renal replacement therapy

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Predicting the future demand for renal
replacement therapy

• P Roderick
• Talk to BRS Workforce Planning Group 11.7.01

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What do we need to know?

• Where are we now, how got there?
• For the future
• input of patients
• population need
• output
• patient survival
• modes of treatment
• mode survival, supply

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Background

• RRT acceptance and prevalence rate increasing
  5-6 pa
• acceptance 20 pmp 1982 rising to 92 pmp 1998
• prevalence RRT 523 pmp in 1998 from 396 pmp in
  1993
• Nature of patients changing
• Patterns of type of RRT changing

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Acceptance rates pmp in the UK 1982-90, England
1991-98
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Patient characteristics of new cases accepted
onto RRT in UK/England ()
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Types of RRT

• Transplantation
• most cost effective but transplant supply doesnt
  meet demand
• Haemodialysis (HD)
• largest growth, more in satellites
• Home HD declining.
• PD slow increase/static
• may not be suitable for many elderly plus
  technique fails with time

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Future input?

• Whats population need?
• Population based incidence studies
• minimal estimate 80 pmp under age 80
• BUT higher 130pmp at 2001..
• Demographic change
• elderly especially ethnic minorities...

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Incidence of chronic renal failure by age (Feest
TG et al)
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Age related acceptance
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(No Transcript)
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Population projections in the UK(1994 based
millions)
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Incidence of ESRF??

• Hypertension detection and control-improvements
  -ve effect on incidence
• Earlier referral of CRF ?-
• note population incidence in caucasian population
  of creatinine gt150 1700pmp (Southampton and SW
  Hampshire HA 1992-4)
• CHD prevention-?
• Type 2 diabetes epidemic ve
• offset by better control?

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Future survival

• Will improved standards of care lead to improved
  survival?
• Will this counterbalance increased co-morbidity
  of new cases?

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Transplantation

• Cadaver mainly
• falling donor rates
• problems with donor supply and matching in ethnic
  minorities
• live donor rates low compared to other countries

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Summary of future pressures

• Incidence ESRF
• rising type 2 diabetes
• demographic change esp ethnic minorities
• Meeting population need
• Transplant supply
• Patient survival

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Aims

• To model RRT demand in England using simulation,
  specifically changing
• acceptance rate
• transplant supply
• patient survival

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1995 Model

• Based on data from National Renal Review 1991-2,
  EDTA and UKTSSA
• When will a steady state be reached?
• Change acceptance rates-
• 1991-2 65pmp, 1995 80pmp, predicted 87pmp
• change transplant supply 10
• improve patient survival

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Simulation modelling

• models
• individuals rather than groups
• models discrete events (e.g. death, modality
  change, change in age band)
• updated each time an event/transition occurs
• flexible to individual characteristics,
  constraints and costs
• handles multiple outcomes
• transitions by probability sampling from any
  distribution

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Prevalence of patients on RRT 1991/2 projected
15 years
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Types of treatment by risk group over 15 years
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Effect of Change in Transplant Supply
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Summary of previous work

• RRT demand set to almost double
• increased proportion on dialysis
• main growth will be in high risk patients
• sensitive to survival and acceptance rate
• transplant supply affects costs

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Current modelling-ongoing

• Update assumption about acceptance rate
• population need estimate higher
• demographic shifts esp. ethnic minority
• separate dialysis modes
• update UKT transplant data
• model constraints e.g. satellite and main HD
  stations, PD
• link with Renal Registry for pt survival,
  dialysis mode survival, acceptance/stock data
• patient choice, early start

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Current Model
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Issues

• Pressure on renal services-facilities, staff,
  costs, quality improvements
• How plan for future?
• growth in stock-which modes, timescale?
• important factors
• limited kidney transplants
• suitability of PD
• HD growth and accessibility
• care of elderly co-morbid patients

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References

• Davies R Roderick P. Predicting the future demand
  for RRT in England using simulation modelling.
  Nephrol Dial Transplant 1997122512-6
• Roderick P, Clements S,Diamond I et al.
  Estimating the demand for RRT in Greater London
  the impact of demographic trends in ethnic
  minority populations. Health Trends
  19983046-50.