Discussion of Paper by Pedersen

The methods of treatment currently applied cannot be regarded as alternatives in the sense that one of them makes the other completely redundant. It also seems to be clear that the largest possible number of transplantations is being advocated and also as much home-dialysis or continuous ambulatory peritoneal dialysis (CAPD) as will then be possible. Because hospital-dialysis will have to continue in any event, the point to be discussed is what would be the ideal mix. Unfortunately, the economic analyses carried out so far have concentrated almost exclusively on a comparative evaluation of the individual methods of treatment. From this it can be deduced — as Pedersen showed very clearly — that at present the important analyses are those that investigate the programme from a comprehensive viewpoint; in the given situation and in view of the high complexity this seems most readily achievable by means of simulation as Pedersen has also indicated in his paper.