Cost of care for patients on maintenance haemodialysis in public facilities in Cameroon

Abstract

Background: The management of end-stage kidney disease constitutes a heavy burden on communities worldwide due to the high cost of renal replacement therapy (RRT). Data on the cost of RRT are scanty in low-income countries. This study aimed to evaluate the global cost of haemodialysis in Cameroon, an emerging economy in Central Africa. This will provide data to help healthcare planners develop more cost-effective strategies for the care of these patients. Methods: A prospective cost analysis of chronic haemodialysis care in three public-sector facilities was conducted in Cameroon. Both incident and prevalent patients were enrolled and followed up for 6 months. Patient data and costs were collected from patient interviews, medical records, bills, hospital price-lists and the procurement departments of the hospitals. Direct medical costs included outpatient consultation fees, dialysis consumables, dialysis session fees, drugs, laboratory and radiological tests. Non-medical direct costs included the cost of transport, feeding, water and electricity. Indirect costs related to the monthly loss of productivity for patients and their caretakers. The annual costs were calculated as the median costs for 6 months multiplied by 2 and were expressed in the local currency, the Central African franc (XAF), and US dollars ($). results: A total of 154 patients (62.3% males), mean age of 46.8 ± 15.2 years, were included, with 6 130 dialysis sessions completed during the study period. The annual median cost of haemodialysis per patient was XAF 7 988 800 ($ 13 581). Out-of-pocket payments amounted to XAF 2 420 300 ($ 4 114), accounting for 30% of the total cost. The median direct cost was XAF 7 458 200 ($ 12 679) and indirect cost XAF 530 600 ($ 902). Direct medical costs accounted for 88%, mainly due to dialysis consumables. In the initiation phase, additional costs of $ 754 were incurred. The cost of hospitalization, laboratory and radiology tests, feeding, consultation fees and some drugs varied significantly among facilities. conclusions: Compared to the national gross domestic product per capita in Cameroon, the cost of care of patients on haemodialysis is high. Out-of-pocket payments are out of the reach of most patients and there is a need for implementing other cost-effective strategies to prevent and manage end-stage kidney disease in our setting.

Comparison Analysis of Hemodialysis Unit Profitability Based on Hospital Rates, Unit Cost and Indonesia Case Base Groups Using Realist Evaluation Analysis at Siloam Hospitals Balikpapan Indonesia in 2018.

“…Some studies that analyze the financing of patients undergoing hemodialysis therapy such as research on the amount of hemodialysis costs indicate that the high total costs required by patients undergoing hemodialysis at home (Komenda et al, 2010), research on estimated dialysis costs by the dialysis procedure itself (Icks et al, 2010). Research with similar findings was also conducted in Cameroon (Halle et al, 2017). Research articles conducted in low-and middle-income countries show that financing of hemodialysis therapy is very large , the findings of the same study conducted in Tanzania found that the cost of hemodialysis is very large for less developed countries .…”

Non-adherence to hemodialysis regimens among patients on maintenance hemodialysis in sub-Saharan Africa: an example from Cameroon

“…Despite government subsidies for HD session in Cameroon, the out pocket expenditure remain high as reported by Halle et al. [ 24 ] and may therefore constitute barriers to accessing treatment. In this study, over 50% of participants had a monthly income less than 50,000 FCFA and about 60% were funded by family and friends renders health education for behavioral change difficult.…”

“…Despite the state subsidies, management of end-stage kidney disease (ESKD) in Cameroon is challenging. Patients have no medical insurance and the out of pocket payment for medications, routine laboratory test, and hospitalizations are very high and not affordable for the majority [ 24 ]. Consequently, morbidity of these patients is high.…”

Markers and risk factors for chronic kidney disease in sub-Saharan Africans: baseline levels and 12-month trajectories in newly referred patients in Cameroon

“…Despite the benefit of early referral on CKD progression, the rate of late referral of patients to the nephrologist is extremely high in SSA [24,25], where access to RRT is limited [26]. Patients with CKD therefore face the problems of high out-of-pocket payment and poor outcome on RRT [27][28][29].…”