Renal replacement therapy (RRT) is the only life-saving type of treatment for end-stage renal disease (ESRD) patients. There are three types of RRT: kidney transplantation, haemodialysis, and peritoneal dialysis. To respond to the growing burden of non-communicable diseases including chronic kidney disease, RRT is now a national issue to consider for government investment under Universal Health Coverage.
However, universal access to RRT is a challenge for low- and middle-income countries due to their high cost. Of the three types, kidney transplantation is the most expensive, given that transplantation services are not widely available in resource-limited settings and as such will require high, intensive capital investment, human resource development, and organ supply, storage, and other related costs. Haemodialysis comes in second for similar reasons – capital investment in machines and human resource development are costly. In addition, physicians have financial incentives to promote this treatment since it will ensure that patients return to clinics or hospitals for treatments several times a week, which may drive up costs if implemented in government-supported facilities.
The last type of RRT, Peritoneal dialysis, has been found cost-effective and has better health outcomes for resource-limited settings (Teerawattananon et al 2016). It also answers unique healthcare challenges in these settings – for example, peritoneal dialysis units can be sent to remote areas that have limited access to healthcare facilities. Thailand has implemented peritoneal dialysis as the first-line treatment to ESRD. This means that patients covered under the universal healthcare scheme will receive peritoneal dialysis as their treatment under public hospitals, with haemodialysis as the secondary treatment in case of contraindications. The country significantly invested and promoted this policy, providing capital investment for PD providers, free training for health professionals, infrastructure development, and a professional fee for health professionals in providing PD services.
On October 13-14 during the International Conference: PD First Policy-Onsite Study, other countries considering their policy for RRT visited Thailand to understand how this policy was enacted and the components of its implementation. The program of activities included a forum that explained the economic and clinical evidence to support peritoneal dialysis for Thailand, the implementation, and the continued management and evaluation of the program. Participants also visited peritoneal dialysis patients and clinics to see first-hand the patient experience on the program. This is particularly important for countries that will be using this information to inform policy on broader level such as Indonesia, which is already implementing pilot programs for RRT and considering scaling them up to the national level.
Reference: Economic Evaluation of Palliative Management versus Peritoneal Dialysis and Hemodialysis for End-Stage Renal Disease: Evidence for Coverage Decisions in Thailand