Willingness to pay for haemodialysis among patients with chronic kidney disease in Abuja, Nigeria

Abstract

Background Evidence of willingness to pay for renal replacement therapy is scarce in low-middle-income countries, including Nigeria's Formal Sector Social Health Insurance Programme. The study, therefore, assessed the willingness to pay for haemodialysis among chronic kidney disease patients in Abuja, Nigeria. Methods The study adopted a cross-sectional survey design. We used the contingent valuation method to estimate the maximum stated willingness to pay (WTP) for haemodialysis among end-stage renal disease (ESRD) patients. The socio-demographic characteristics and willingness to pay data were summarized using descriptive statistics. We evaluated the mean differences in respondents' WTP using Mann-Whitney and Kruskal-Wallis tests. All variables that had p < 0.25 in the bivariate analysis were included in the Generalized Linear Model (gamma with link function) to determine the predictors of the WTP for one's and another's haemodialysis. The level of significance in the final model was ρ < 0.05. Results About 88.3% and 64.8% of patients receiving haemodialysis were willing to pay for their haemodialysis and others, correspondingly. The mean annual WTP for haemodialysis for one’s and altruistic haemodialysis was USD25,999.06 and USD 1539.89, respectively. Private hospital patients were likelier to pay for their haemodialysis (β = 0.39, 95%CI: 0.21 to 0.57, p < 0.001). Patients attending public-private partnership hospitals were less likely to pay for altruistic haemodialysis than those attending public hospitals (β = -1.65, 95%CI: -2.51 to -0.79, p < 0.001). Conclusions The findings highlight the need for policies to promote affordable access to haemodialysis for all socioeconomic groups. Pre-payment mechanisms should be explored rather than out-of-pocket payments which pose financial hardships. The potential for altruistic financing strategies should also inform the redesign of funding policies to enhance equitable access.