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

Demand for Renal Demand for Renal Replacement TherapyReplacement Therapy

International Health Policy International Health Policy ProgramProgram

Source: Witt K. Demand for RRT. IHPP [presentation] 2004.

Incidence (new cases) of end-stage Incidence (new cases) of end-stage renal disease (ESRD)renal disease (ESRD)

In USA In USA 82 pmp.* in 198082 pmp.* in 1980 203 pmp. in 1990203 pmp. in 1990 334 pmp. in 2001334 pmp. in 2001

European Union (EU)European Union (EU) 120 pmp. in 1995120 pmp. in 1995 From 68 pmp. in Finland to 163 pmp. in From 68 pmp. in Finland to 163 pmp. in

GermanyGermany

* per million population* per million population

Incidence in ThailandIncidence in Thailand

In ThailandIn Thailand From 49.4 pmp.* to 107 pmp.** in 1998From 49.4 pmp.* to 107 pmp.** in 1998

Damrongkitchaiporn et al. 2004 Damrongkitchaiporn et al. 2004 reported incidence at 222 pmp. reported incidence at 222 pmp.

* Average from 3 provinces: Songkla, Ubonrachatani, and * Average from 3 provinces: Songkla, Ubonrachatani, and Nakornsawan. Nakornsawan.

** in Chiengmai ** in Chiengmai

Access to renal replacement Access to renal replacement therapy (RRT) in Thailandtherapy (RRT) in Thailand

From Thailand Renal Replacement From Thailand Renal Replacement Therapy Registry (TRT) in 2004Therapy Registry (TRT) in 2004 Incidence 62.5 pmp. ( 3,998 cases)Incidence 62.5 pmp. ( 3,998 cases) Prevalence 175.2 pmp (11,208 Prevalence 175.2 pmp (11,208

cases)cases)

Source: Witt K. Demand for RRT. IHPP [presentation] 2004.

Burden of disease in ThailandBurden of disease in Thailand

From TRT report in 2004, incidence From TRT report in 2004, incidence of RRT was 62.5 PMP and the of RRT was 62.5 PMP and the proportion of non-UC population was proportion of non-UC population was one-fourth in 2003. one-fourth in 2003.

Incidence should be 250 PMP.Incidence should be 250 PMP. However, some UC patients also had However, some UC patients also had

access to RRT, therefore 250 PMP access to RRT, therefore 250 PMP may be a high estimation. may be a high estimation.

Cost of kidney transplantation (KT)Cost of kidney transplantation (KT)

Surgery cost 165,479 bahtSurgery cost 165,479 baht Organ harvesting would be 50,000 Organ harvesting would be 50,000

bahtbaht Follow up cost 14,668 baht/visit:Follow up cost 14,668 baht/visit:

16 times in the first year 234,688 baht16 times in the first year 234,688 baht 6 times in the following year 88,008 baht6 times in the following year 88,008 baht

Total cost in the first yearTotal cost in the first year

450,167 baht450,167 baht

Cost from Societal PerspectiveCost from Societal Perspective

(Baht/patient/yr) HD CAPD(Baht/patient/yr) HD CAPD Medical cost 248,000 Medical cost 248,000

220,000220,000 Non-Medical cost 65,000 Non-Medical cost 65,000

6,0006,000 Total Cost 313,000 Total Cost 313,000

226,000226,000

Cost of a program to support RRTCost of a program to support RRT

At incidence of ESRD 150 - 250 pmp.At incidence of ESRD 150 - 250 pmp. Cost of dialysis at 250,000 baht/yearCost of dialysis at 250,000 baht/year Survival rate of dialysis patients was Survival rate of dialysis patients was

derived from TRT data. derived from TRT data. Cost of a program to support all Cost of a program to support all

ESRD patient would be 10,000 million ESRD patient would be 10,000 million baht within 3-5 years and 20,000 baht within 3-5 years and 20,000 million baht within 7-10 years.million baht within 7-10 years.

An Estimation of ESRD Patients by the Year An Estimation of ESRD Patients by the Year 2024 at 150 PMP2024 at 150 PMP

35,387

107,003

99,278

61,942

72,551

85,757

93,034

9,795

2,449

6,863 12,40918,138

23,258 26,751

-

20,000

40,000

60,000

80,000

100,000

120,000Living w/RRT100%

Living w/RRT50%

Lving w/RRT25%

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

58,978

178,339

165,463

103,236

120,919

142,929

155,056

16,325

4,081

11,439 20,68130,230

38,764 44,585

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000 Living w/RRT100%

Living w/RRT50%

Lving w/RRT25%

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

Cost of a Program to Support RRT

2448.75

4733.55

10692.3

15485.4

20420.7

24819.4526750.85

17162673

42155105 5815 6378 6688

0

5000

10000

15000

20000

25000

30000

1 3 5 7 9 11 13 15 17 19

Years of the program

Mill

ion

ba

ht

100% access

25% access

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

Cost of a Program to Support RRT

4081

25809

40115

44585

36865835

8051

35732

20681

11439

30230

11146103419327

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Year from now

Mil

lio

n b

ah

t 100% access

25% access

SummarySummary Estimated burden of diseaseEstimated burden of disease

IncidenceIncidence of RRT of RRT was 62.5 PMP (3,998 was 62.5 PMP (3,998 cases) in 2004.cases) in 2004.

Incidence of ESRD was estimated from Incidence of ESRD was estimated from 150 to 250 PMP (9,795 to 15,992 150 to 250 PMP (9,795 to 15,992 cases) in the year 2004.cases) in the year 2004.

Prevalence of RRT is 175.2 PMP Prevalence of RRT is 175.2 PMP (11208 cases)(11208 cases)

Prevalence of RRT is estimated to be Prevalence of RRT is estimated to be 1487 to 2479 PMP (107,003 to 1487 to 2479 PMP (107,003 to 178,339 cases) in the year 2024178,339 cases) in the year 2024

SummarySummary

Financial burdenFinancial burden If the government intends to support all If the government intends to support all

ESRD patients, the financial burden in ESRD patients, the financial burden in 2020 for RRT would range from 24,068 - 2020 for RRT would range from 24,068 - 40,115 million baht that are40,115 million baht that are

3.8 to 6.4 % of total health expenditure 3.8 to 6.4 % of total health expenditure (628,047 million baht in 2020) for a group of (628,047 million baht in 2020) for a group of 0.2% of population (70.2 million in 2020) . 0.2% of population (70.2 million in 2020) .

15 to 25% of expenditure of universal 15 to 25% of expenditure of universal coverage program (159,003 million baht in coverage program (159,003 million baht in 2020). 2020).

Discussion Discussion

What are appropriate approaches to What are appropriate approaches to increase access to RRT?increase access to RRT?

Does cost-effectiveness analysis help us Does cost-effectiveness analysis help us to answer this?to answer this?

Is rationing health care inevitable? Is rationing health care inevitable? If it is inevitable to ration care, how can If it is inevitable to ration care, how can

we make it acceptable?we make it acceptable? Do we have other ways to choose?Do we have other ways to choose?

a Monetary value in US$ at year 2002

a Monetary value in US$ at year 2002