The burden of end-stage renal disease in Khartoum, Sudan: cost of illness study

Abstract

Background and purpose

The incidence of end-stage renal disease (ESRD) in Sudan is increasing, affecting the economic status of patients, caregivers and society. This study aimed to measure ESRD’s costs, including direct and morbidity indirect expenditures, and to investigate any associated factors and financial consequences.

Materials and methods

This cross-sectional study used a standardized questionnaire to collect data from 150 ESRD patients who had been receiving dialysis for at least one year before the time of data collection at 13 specialized renal centres in Khartoum state. Data about sociodemographic, clinical, and economic factors were gathered, and their relationship to the cost of ESRD was examined using both bivariate (Man Whitney test, Kruskal Wallis test and Spearman correlation) and multivariate analytical procedures (multivariate linear regression).

Results

This study reported a median direct per capita ESRD cost of 38 600 SDG ($1 723.2 PPP) annually with an interquartile range of 69 319.3 SDG ($3 094.6 PPP). The median morbidity indirect cost was estimated to be 0.0 ± 3 352 SDG ($ 0.0 ± 149.6 PPP) per annum. In 28.8% of cases, the patients were their family’s primary income earner and over 85% were covered by medical insurance. Our study found that none of the study variables were significantly associated with the total cost of ESRD.

Conclusion and limitations

Our findings point out considerable direct out-of-pocket expenses and productivity losses for patients and their households. However, these results should be carefully applied for comparison between the different countries due to differences in the cost of medical interventions and insurance coverage. Further longitudinal studies and studies on health finance and insurance policies are recommended.

PLAIN LANGUAGE SUMMARY

As medical care costs continue to rise in Sudan, this study aimed to estimate direct and indirect costs associated with end-stage renal disease (ESRD) from the patient’s perspective. Accurate information on the cost of illness (COI) helps policymakers prioritize healthcare services and resources, optimize public well-being, and determine health policy effectiveness. Future research should include a longitudinal design and understand ESRD costs from caregivers’ and healthcare providers’ perspectives.

Keywords:

• Cost of illness
• health economics
• end-stage renal disease
• chronic kidney disease
• burden of kidney disease

JEL CLASSIFICATION CODES:

• I10
• I1
• I
• I11

Transparency

Declaration of funding

This study wasn’t funded by any organization.

Declaration of financial/other section

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Author contributions

HAH and OAE made the study plan. All authors conducted the analysis, interpreted the results, and drafted, revised, and approved the final manuscript, first authors had equal contributions and order was made on an alphabetic basis. The authors read and approved the final manuscript and agree to be accountable for all aspects of the work.

Acknowledgements

This work was under the supervision of the Student Association of Medical Education and Research (SAMER) and Khartoum Medical Student Association (KMSA), University of Khartoum, Khartoum, Sudan

Data availability statement

The data that support the findings of this study are available from the corresponding author (SOE) upon reasonable request.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Consent and ethical approval

All methods of ethical approval followed the Declaration of Helsinki by the research ethics committee at the Ministry of Health in Khartoum State. Permission was then taken from dialysis centres’ administration. ESRD patients gave their voluntary informed consent after the research objectives and processing of data collection were clarified in simple terms. Participants were not harmed by any means and the confidentiality of their information was ensured throughout different stages of this research. The researchers declare no conflict of interest.