Abstract for:Evaluating the Impact of Upstream and Downstream Interventions on Chronic Kidney Disease and Dialysis Care: A Simulation Analysis

The aging population, coupled with increasing prevalence of diabetes and hypertension is expected to increase the number of people in developing and developed countries with chronic kidney diseases (CKD), and consequently the need for dialysis. This paper explores the impact of upstream and downstream interventions on future number of people with CKD and patients needing dialysis in Singapore. A system dynamics simulation model was developed based on national data from Singapore Renal Registry. The results indicate that under the business-as-usual scenario (base-case), the number of people with CKD (including CKD3 to CKD5) is projected to increase from 303,600 in year 2000 to 543,916 (534,118-551,714) by 2040. As a result, people requiring dialysis (dialysis patients) are projected to increase from 3,273 in year 2000 to 13,277 (13,180-13,374) by 2040. Accordingly, the cost of providing dialysis care, under the base-case, is projected to increase from S$66.4 million in year 2000 to S$527.6 million (S$523.7- S$531.5 million) by 2040. The policy experiments clearly indicate that a combined upstream and downstream policy will results in a cumulative savings of S$1.2 billion, from year 2000 to 2040, compared to what it would have been under the business-as-usual scenario.