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Demand for Renal Replacement Therapy

Demand for Renal Replacement Therapy. International Health Policy Program. Source: Witt K. Demand for RRT. IHPP [presentation] 2004. Incidence (new cases) of end-stage renal disease (ESRD). In USA 82 pmp.* in 1980 203 pmp. in 1990 334 pmp. in 2001 European Union (EU) 120 pmp. in 1995

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Demand for Renal Replacement Therapy

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  1. Demand for Renal Replacement Therapy International Health Policy Program Source: Witt K. Demand for RRT. IHPP [presentation] 2004.

  2. Incidence (new cases) of end-stage renal disease (ESRD) • In USA • 82 pmp.* in 1980 • 203 pmp. in 1990 • 334 pmp. in 2001 • European Union (EU) • 120 pmp. in 1995 • From 68 pmp. in Finland to 163 pmp. in Germany * per million population

  3. Incidence in Thailand • In Thailand • From 49.4 pmp.* to 107 pmp.** in 1998 • Damrongkitchaiporn et al. 2004 reported incidence at 222 pmp. * Average from 3 provinces: Songkla, Ubonrachatani, and Nakornsawan. ** in Chiengmai

  4. Access to renal replacement therapy (RRT) in Thailand • From Thailand Renal Replacement Therapy Registry (TRT) in 2004 • Incidence 62.5 pmp. ( 3,998 cases) • Prevalence 175.2 pmp (11,208 cases) Source: Witt K. Demand for RRT. IHPP [presentation] 2004.

  5. Burden of disease in Thailand • From TRT report in 2004, incidence of RRT was 62.5 PMP and the proportion of non-UC population was one-fourth in 2003. • Incidence should be 250 PMP. • However, some UC patients also had access to RRT, therefore 250 PMP may be a high estimation.

  6. Cost of kidney transplantation (KT) • Surgery cost 165,479 baht • Organ harvesting would be 50,000 baht • Follow up cost 14,668 baht/visit: • 16 times in the first year 234,688 baht • 6 times in the following year 88,008 baht • Total cost in the first year 450,167 baht

  7. Cost from Societal Perspective (Baht/patient/yr) HD CAPD • Medical cost 248,000 220,000 • Non-Medical cost 65,000 6,000 • Total Cost 313,000 226,000

  8. At incidence of ESRD 150 - 250 pmp. Cost of dialysis at 250,000 baht/year Survival rate of dialysis patients was derived from TRT data. Cost of a program to support all ESRD patient would be 10,000 million baht within 3-5 years and 20,000 million baht within 7-10 years. Cost of a program to support RRT

  9. An Estimation of ESRD Patients by the Year 2024 at 150 PMP

  10. An Estimation of the Number of ESRD Patients to the Year 2024 at 250 PMP

  11. Cost of a Program to Support all ESRD Patient; Incidence at 150 PMP and 250,000 baht/patient

  12. Cost of a program to Support all ESRD patient; Incidence at 250 PMP and 250,000 baht/patient

  13. Summary • Estimated burden of disease • Incidence of RRT was 62.5 PMP (3,998 cases) in 2004. • Incidence of ESRD was estimated from 150 to 250 PMP (9,795 to 15,992 cases) in the year 2004. • Prevalence of RRT is 175.2 PMP (11208 cases) • Prevalence of RRT is estimated to be 1487 to 2479 PMP (107,003 to 178,339 cases) in the year 2024

  14. Summary • Financial burden • If the government intends to support all ESRD patients, the financial burden in 2020 for RRT would range from 24,068 - 40,115 million baht that are • 3.8 to 6.4 % of total health expenditure (628,047 million baht in 2020) for a group of 0.2% of population (70.2 million in 2020) . • 15 to 25% of expenditure of universal coverage program (159,003 million baht in 2020).

  15. Discussion • What are appropriate approaches to increase access to RRT? • Does cost-effectiveness analysis help us to answer this? • Is rationing health care inevitable? • If it is inevitable to ration care, how can we make it acceptable? • Do we have other ways to choose?

  16. a Monetary value in US$ at year 2002

  17. a Monetary value in US$ at year 2002

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