Long-Term Projections of Patients Undertaking Renal Replacement Therapy Under the Universal Coverage Scheme in Thailand

Abstract

Introduction

The increasing number of patients with end-stage renal disease and the cost of their treatment may potentially place a large burden on overall healthcare spending and human resources for health. We projected the number of patients with end-stage renal disease to better estimate arrangements needed in the future.

Materials and Methods

We used a dataset containing information about patients who registered with the three modalities of the renal replacement therapy (RRT) program from 2009 to 2017: continuous automated peritoneal dialysis (CAPD), hemodialysis (HD) and kidney transplant (KT). An autoregressive integrated moving average model was used to predict the number of patients who would enroll in the RRT program from 2018 to 2027.

Results

From 2009 to 2017, there was a constant increase in the volume of CAPD patients, although a slight drop in some periods was observed. HD patients outnumbered CAPD patients during the inception period of the program. After mid-2013, the trend in HD patients accelerated to the same pace as CAPD patients. By the end of 2017, the number of patients increased to 20,000 for CAPD and 15,000 for HD. The number of KT patients was extremely small relative to CAPD and HD patients. The program enrolled patients receiving a kidney transplant at a constant rate of approximately 200 per year after 2013. The predicted numbers of patients on RRT corresponded to an annual growth rate of 7.2–7.4% for CAPD and HD and 4.8% for KT.

Conclusion

Despite the expected increased volume of patients, the year-by-year growth rate of patients in all RRT modalities seemed to diminish over time. This phenomenon is likely explained by the intensive implementation of policies to address risk factors of non-communicable diseases among Universal Coverage Scheme (UCS) beneficiaries.

Keywords:

• dialysis
• kidney transplant
• universal health coverage
• ARIMA

Acknowledgments

The authors thank the NHSO in particular for providing data on the RRT patients. Advice from Prof Supon Limwattananon and Prof Anne Mills is immensely appreciated.

Ethics Approval

This study obtained ethics approval from the Institute for the Development of Human Research Protections (IHRP) of Thailand; approval date 25 February 2015.

Author Contributions

Both authors contributed to the study concept and design, methodology, data interpretation, data analysis, drafting and revising the article (including the final draft), gave final approval of the version to be published, and agree to be accountable for all aspects of the work. NT had full access to all of the data in the study and took responsibility for the accuracy of the data analysis.

Disclosure

The authors declare no conflicts of interest.

Additional information

Funding

The authors give particular thanks to the funding support through the International Health Policy Program (IHPP) from the Thailand Science Research and Innovation (TSRI) under the Senior Research Scholar on Health Policy and System Research [Contract No. RTA6280007].