By: Alia Luz, Health Intervention and Technology Assessment Program (HITAP)
In 2007, there were an estimated 58 million deaths worldwide and, according to the WHO, more than half (35 million) were caused by chronic diseases. Another study estimates that deaths caused by chronic diseases will rise to 50 million in 2020. The economic burden of these diseases is enormous. By 2015, an estimated reduction of 5% on GDP will be due to funds channeled into healthcare spending on just two of these diseases – diabetes and cardiovascular disease. Studies show that low- and middle-income countries, elderly patients, and those coming from lower income brackets bear the brunt of the increasing risk and economic burden of these diseases. Despite this, chronic kidney disease (CKD) is generally not included in the list of priorities for governments and international donors. And with governments around the world committing to Universal Health Coverage (UHC) for their citizens, priority-setting for treatments of chronic diseases – and CKD – is a must.
Preferred treatment is usually the more expensive and less logistically efficient in-clinic hemodialysis (HD) rather than the home kit peritoneal dialysis (PD). PD has several advantages: it is three times less expensive than HD, it can be done at home and reduce the three whole-day trips per week done for the HD procedure, less manpower is required, and there is no difference between HD and PD in clinical outcomes. As a result of their UHC commitment, several governments (Thailand and Hong Kong, in particular) have successfully enacted the ‘PD First’ policy as their primary treatment for renal diseases. Implementing such a policy in other countries increasingly became vital.
On November 27-28, 2014, an international forum on elevating this topic as a priority in Asia was conducted through the collaboration of Thailand’s Department of Medical Services under the Ministry of Public Health, the Nephrology Society of Thailand, the National Health Security Office, the Kidney Foundation of Thailand, Mahidol University Global Health unit, the Rockefeller Foundation, NICE International, and the Health Intervention and Technology Assessment Program (HITAP). The objectives were important for developing and developed countries considering such a scheme: to share knowledge and experiences about enacting this policy; strengthen institutional and international networks to push the policy through; and spread awareness of the PD First Policy beyond their borders, regionally and globally.
The two-day forum was opened by the Minister of Public Health, Dr. Ratchata Ratchatanawin, and had an informative field visit to various hospitals and patients’ homes with PD treatments. Topics spanned the range from the global burden of the disease, end stage renal disease (ESRD) experiences and policies in Thailand and the UK, the policy challenges in implementing PD First policy under the UHC for ESRD patients, clinical innovation to improve quality of care in PD, and psychosocial innovation for PD for improved quality of life. Delegates came from both the public and private sectors in Cambodia, Hong Kong, India, Indonesia, Lao, Malaysia, the Philippines, Singapore, Thailand, Taiwan and the United Kingdom; speakers included prominent movers and shakers in the field. Such that the physical, psychological and economic burden is mitigated for the individual patient and the government(s), collaboration among and between countries to push this policy forward was also discussed, and future conferences were considered to explore next steps and ways on progressing in this goal. Lessons learned, information, and outcomes from this forum will be documented in a report to be made available early next year on the International Decision Support Initiative (iDSI) and HITAP websites.