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Projecting demands for renal replacement therapy in the Northern Territory: A stochastic Markov model
Objective: To evaluate the potential impacts 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 ten years, based on RRT registry data between 2002 and 2013. Four policy relevant scenarios were evaluated: increased Tx, increased self-care dialysis, reduced end-stage kidney disease (ESKD) incidence and reduced mortality. Results: There were 957 new cases of ESKD during the study period, with a majority being Indigenous people (85%). The median age was 50 years at onset and 57 at death, 12 and 13 years younger than the Australian averages. RRT prevalence 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%CI: 75,000-121,000) in 2023, 5% increase annually. Increasing Tx (0.3%), increasing self-care (5%) and reducing incidence (5%) each attenuate demand for FHD to about 70,000 annually by 2023. Conclusions: This study demonstrates the effects of changing service patterns to increase Tx, self-care and prevention, which will substantially attenuate the growth in FHD requirement in the NT.
AH16156 Accepted 02 April 2017
© CSIRO 2017