Projecting demands for renal replacement therapy in the Northern Territory: a stochastic Markov model

2018 ◽  
Vol 42 (4) ◽  
pp. 380 ◽  
Author(s):  
Jiqiong You ◽  
Yuejen Zhao ◽  
Paul Lawton ◽  
Steven Guthridge ◽  
Stephen P. McDonald ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Markov Model ◽  
Replacement Therapy ◽  
Management Practices ◽  
Markov Models ◽  
Self Care ◽  
Potential Effect ◽  
Northern Territory ◽  
Baseline Scenario ◽  
On Demand

Objective The aim of the present study was to evaluate the potential effects of different health intervention strategies on demand for renal replacement therapy (RRT) services in the Northern Territory (NT). Methods A Markov chain simulation model was developed to estimate demand for haemodialysis (HD) and kidney transplantation (Tx) over the next 10 years, based on RRT registry data between 2002 and 2013. Four policy-relevant scenarios were evaluated: (1) increased Tx; (2) increased self-care dialysis; (3) reduced incidence of end-stage kidney disease (ESKD); and (4) reduced mortality. Results There were 957 new cases of ESKD during the study period, with most patients being Indigenous people (85%). The median age was 50 years at onset and 57 years at death, 12 and 13 years younger respectively than Australian medians. The prevalence of RRT increased 5.6% annually, 20% higher than the national rate (4.7%). If current trends continue (baseline scenario), the demand for facility-based HD (FHD) would approach 100 000 treatments (95% confidence interval 75 000–121 000) in 2023, a 5% annual increase. Increasing Tx (0.3%), increasing self-care (5%) and reducing incidence (5%) each attenuate demand for FHD to ~70 000 annually by 2023. Conclusions The present study demonstrates the effects of changing service patterns to increase Tx, self-care and prevention, all of which will substantially attenuate the growth in FHD requirements in the NT. What is known about the topic? The burden of ESKD is projected to increase in the NT, with demand for FHD doubling every 15 years. Little is known about the potential effect of changes in health policy and clinical practice on demand. What does this paper add? This study assessed the usefulness of a stochastic Markov model to evaluate the effects of potential policy changes on FHD demand. What are the implications for practitioners? The scenarios simulated by the stochastic Markov models suggest that changes in current ESKD management practices would have a large effect on future demand for FHD.

scholarly journals Robotic Versus Open Renal Transplantation in Obese Patients: Protocol for a Cost-Benefit Markov Model Analysis (Preprint)

2017 ◽  
Author(s):  
Michele Molinari ◽  
Chethan Puttarajappa ◽  
Martin Wijkstrom ◽  
Armando Ganoza ◽  
Roberto Lopez ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Renal Transplantation ◽  
Renal Replacement Therapy ◽  
Renal Transplant ◽  
Markov Model ◽  
Replacement Therapy ◽  
Controlled Trial ◽  
Cost Benefit ◽  
Obese Patients ◽  
Robotic Assisted

BACKGROUND Recent studies have reported a significant decrease in wound problems and hospital stay in obese patients undergoing renal transplantation by robotic-assisted minimally invasive techniques with no difference in graft function. OBJECTIVE Due to the lack of cost-benefit studies on the use of robotic-assisted renal transplantation versus open surgical procedure, the primary aim of our study is to develop a Markov model to analyze the cost-benefit of robotic surgery versus open traditional surgery in obese patients in need of a renal transplant. METHODS Electronic searches will be conducted to identify studies comparing open renal transplantation versus robotic-assisted renal transplantation. Costs associated with the two surgical techniques will incorporate the expenses of the resources used for the operations. A decision analysis model will be developed to simulate a randomized controlled trial comparing three interventional arms: (1) continuation of renal replacement therapy for patients who are considered non-suitable candidates for renal transplantation due to obesity, (2) transplant recipients undergoing open transplant surgery, and (3) transplant patients undergoing robotic-assisted renal transplantation. TreeAge Pro 2017 R1 TreeAge Software, Williamstown, MA, USA) will be used to create a Markov model and microsimulation will be used to compare costs and benefits for the two competing surgical interventions. RESULTS The model will simulate a randomized controlled trial of adult obese patients affected by end-stage renal disease undergoing renal transplantation. The absorbing state of the model will be patients' death from any cause. By choosing death as the absorbing state, we will be able simulate the population of renal transplant recipients from the day of their randomization to transplant surgery or continuation on renal replacement therapy to their death and perform sensitivity analysis around patients' age at the time of randomization to determine if age is a critical variable for cost-benefit analysis or cost-effectiveness analysis comparing renal replacement therapy, robotic-assisted surgery or open renal transplant surgery. After running the model, one of the three competing strategies will result as the most cost-beneficial or cost-effective under common circumstances. To assess the robustness of the results of the model, a multivariable probabilistic sensitivity analysis will be performed by modifying the mean values and confidence intervals of key parameters with the main intent of assessing if the winning strategy is sensitive to rigorous and plausible variations of those values. CONCLUSIONS After running the model, one of the three competing strategies will result as the most cost-beneficial or cost-effective under common circumstances. To assess the robustness of the results of the model, a multivariable probabilistic sensitivity analysis will be performed by modifying the mean values and confidence intervals of key parameters with the main intent of assessing if the winning strategy is sensitive to rigorous and plausible variations of those values.

scholarly journals Study Protocol for ‘Patient Referral and Education Program prior to Renal Replacement Therapy (PREP-RRT)”:

2019 ◽  
Vol 2 ◽  
pp. 1-9
Author(s):  
Milda Saunders ◽  
Akilah King ◽  
Eric Robinson ◽  
Fanny Lopez ◽  
Michael Quinn ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
African Americans ◽  
Replacement Therapy ◽  
Education Program ◽  
Treatment Options ◽  
Self Care ◽  
Or Education ◽  
Patient Referral ◽  
Receive Treatment ◽  
Satisfaction With Education

Patients with advanced stages of chronic kidney disease (CKD), especially racial minorities, often do not receive treatment or education until specific symptoms begin to manifest. The Patient Referral and Education Program prior to Renal Replacement Therapy (PREP-RRT) study is intended to capture the perspective of African Americans receiving renal care and then tailor education for hospitalized patients who may not be well linked to the medical system. In the U.S., African Americans and other minorities are less likely to be seen by a nephrologist prior to dialysis and the lack of pre-dialysis care and education is associated with lower likelihood of pre-emptive transplant. The primary outcome for the PREP-RRT study will be change in patient knowledge, attitudes and behavior about CKD treatment options which will be assessed by the previously validated Kidney Knowledge Survey (KiKS). Secondary outcomes of interest are patient satisfaction with education, time-to-event for nephrology appointment, appearance at transplant center, likelihood of fistula, self-care dialysis at dialysis initiation, or documentation of patient decision not to initiate RRT. The PREP RRT intervention will identify, educate and motivate patients to increase CKD self-care and to improve communication and shared decision-making about RRT treatments among patients, their families and their providers.

Project of the Health Policy Program: Access to Vessels in Renal Replacement Therapy - Fistula First / Catheter Last

2020 ◽  
Vol 92 (1) ◽  
pp. 1-5
Author(s):  
Grzegorz Kubielas
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Vascular Access ◽  
Self Care ◽  
Care Organization ◽  
Arteriovenous Anastomosis ◽  
Number Of Patients ◽  
Policy Program

The number of patients with end-stage renal failure (ESRF) that require inclusion in the renal replacement therapy program (RRT) is steadily increasing. This fact caused an increase in vascular operations involving the production of vascular access. According to the current guidelines, the best and safest option for a patient with chronic kidney disease (CKD) is the early creation of arteriovenous fistula (AVF). An efficient vascular access to haemodialysis determines the procedure and directly affects the quality of life of a patient with CKD. The aim of this paper is to present the author's project of the health policy program „Vascular access in renal replacement therapy - fistula first / catheter last", the essence of which is to assess the practical effectiveness and develop an optimal model of CKD patient care organization qualified for the chronic RRT program. The target population of the program consists of all patients diagnosed with CKD, qualified for the RRT program. The basic measures of the program's effectiveness include: (1) reduction in the number of re-hospitalizations related to vascular access, (2) reduction in the number of complications associated with haemofiltration surgery, (3) reduction in general mortality among patients undergoing dialysis in a 12-month perspective, (4) increasing knowledge in the field of self-care and self-care of arteriovenous anastomosis, and (5) creating a register of vascular access in Poland. To sum up, health policy programme "Vascular access in renal replacement therapy - fistula first / catheter last" covering health care services provided in the scope and on the conditions specified in the regulations issued on the basis of article 31d of the Act of 27 August 2004 on health care benefits financed from public funds, is to check whether planned changes in the organization and delivery of services will improve the situation of patients with CKD eligible for chronic RRT and whether it will be effective the point of view of the health care system.

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