SIMULATION-MODEL FOR PLANNING RENAL SERVICES IN A DISTRICT HEALTH AUTHORITY

Objective-To investigate the use of a computer simulation model in planning and budgeting for renal replacement services. Setting-Regional renal unit. Results-The simulation provided projections that accurately reflected the actual numbers of people maintained on different forms of renal replacement therapy in previous years. Projections up to the end of the century showed that with no change in the demand for the service the total number of people on the renal replacement programme would increase by 40%. Increasing the uptake of new patients from 40 per million to 55 per million would mean an increase of 66% in patient numbers over the same period. Similarly, at present day prices the cost of providing the service would rise by 31% with no change in demand and by twice this with the greater uptake of new patients. Increasing the number of transplant operations was shown to offer little prospect of a reduction in these costs. Conclusion-The simulation program could be used by individual renal units to evaluate different treatment policies and to budget for resource use. Even at current demand levels resource requirements for renal replacement therapy win continue to grow until after the end of the century.