Economic burden of hemodialysis among patients with chronic kidney disease in Dar es-Salaam region in Tanzania - a cross-sectional study.

backgroundChronic Kidney Disease (CKD) is a major public health problem with increasing morbidity and mortality, and with high cost to patients and the health care system. This study aims to estimate the patient's cost, incidence of catastrophic health expenditure, and factors influencing the cost of hemodialysis in Dar es-Salaam region, Tanzania.

methodsThis cross-sectional study included 437 CKD patients who were on hemodialysis in eight centres. Data was collected in two rounds between March and April 2023 and April to May 2024 by interviewing patients or caregivers using a pre-tested questionnaire. Cost data were collected in Tanzanian shillings (TZS) and converted to 2024 US dollars ($), using the exchange rate of 1$ = 2,314 TZS. Data was analyzed with Stata 18. A mixed-effects generalized linear model (GLM) with gamma distribution was used to assess the association of independent variables with hemodialysis cost. The incidence of catastrophic health expenditure (CHE) was calculated as the proportion of households whose annual spending on hemodialysis treatment exceeded 10% or 25% of their average annual household income.

resultsThe average annual cost of hemodialysis was $3,099. Direct medical costs contributed 49.1% ($1,523), direct non-medical costs 20.8% ($645), and indirect costs 30.1% ($931). The economic burden was four times higher among patients who solely paid in cash compared to those who were fully insured i.e. $7,9301 versus $1,958. Only 40% of patients reported they were still working after starting hemodialysis; however, on average, they missed about 12 working days every month. Proportion of 0.91 patients incurred annual hemodialysis treatment costs that exceeded 10% of their annual income, while 0.77 patients experienced treatment costs that exceeded 25% of their income. The patients' cost of hemodialysis was significantly associated with having a monthly income greater than $217, solely paying in cash, receiving full or partial exemption, having partial insurance, undergoing hemodialysis for two to three years, and attending more than one hemodialysis session per week.

conclusionThe economic burden of hemodialysis is particularly high among patients who pay out-of-pocket compared to those with health insurance coverage, contributing to a significantly higher incidence of catastrophic health expenditure among uninsured patients (91% vs. 77%). Therefore, the government must implement policies that protect patients without health insurance, as they remain at substantial risk of being driven into impoverishment and poverty.