Modelling future renal dialysis requirements under various scenarios of organ availability in Australia

The rate of dialysis uptake in Australia has been increasing and in 1996 was 77 per million people per year (pmp). The rate of kidney transplantation in Australia is at the same time falling. We have developed a computer model to enable predictions of the number of dialysis patients to 2007, under several scenarios of organ availability. We also aimed to examine the cost implications of the predictions. The number of existing and new dialysis and transplant patients was obtained from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) for the years 1988-95. Age-stratified transition coefficients for dialysis uptake, transplantation, graft failure and dialysis and transplant death were calculated for this time period. Data from 1995 were used as the baseline year in the application of the model and the calculated transition coefficients applied for this year. Scenarios of organ availability examined were the current trend continued, stabilization of the current Australian rate (23 pmp), the South Australian rate (35 pmp) achieved nationally and the Spanish rate (47 pmp) achieved nationally. Validation of the model using 1997 data was performed. Direct costs for dialysis and transplantation were obtained from a major teaching hospital in Melbourne. The number on dialysis is predicted to increase from 5648 in 1998 to 11 803 by 2007. If the transplant rate is increased from 23 pmp to 'the world best practice transplantation rate' (47 pmp) the predicted dialysis number in 2007 would be 8476. This is associated with a direct cost saving in comparison to the current trend of 82 million dollars (1998 Australian dollars). Assuming the Australian population increases as predicted and that current trends in dialysis uptake and transplantation continue, dialysis numbers are predicted to more than double over the next 10 years. In order to limit the potential human and economic cost of renal replacement therapy, this model indicates that attempts to increase organ availability are worthwhile.