Purchasing services for end stage renal failure: the potential and limitations of existing information sources.

Renal replacement therapy services already consume considerable health service resources and, as patient stock levels rise and unmet need continues to be identified, the pressure to spend more on renal services will increase. Purchasers of services must decide how to respond to these pressures, and a clear assessment of need and the effectiveness and efficiency of services are key issues when contracts are being developed for such services. This paper reports an examination of the quality and potential of information currently available from routine data sources to support the contracting process. The results expose gaps in current knowledge and identify areas for future research. Locally, purchasers should consider surveying their population to identify the incidence of renal disease, including the reasons for any unmet need. Nationally, research is required to investigate the following: the relationship between ethnicity and the development of renal disease; the criteria for allocating patients to the alternative treatment modalities; and the treatments in terms of their costs and cost-effectiveness.