Use of simulation to determine resource requirements for end-stage renal failure

All Western countries are taking increasing numbers of patients onto their renal programs. Physicians now accept older and sicker patients than they would have done in the past. A discrete event simulation describes patient arrivals and the transfer between three modalities of treatment for different age and risk groups in order to project future demands for treatment. In the UK, at the national level the main uncertainty arises from the expected number of new patients, which is on an upward trajectory and has not yet reached the level of most other European countries or the USA. At a local level the uncertainties are much greater because of the inherent randomness in smaller populations. In these smaller populations, simpler modeling methods that only take account of new arrivals, transplant and death rates may be equally valuable, providing that the standard deviations of the estimates can be calculated.