Cost of Hemodialysis Treatment and Associated Factors Among End-Stage Renal Disease Patients at the Tertiary Hospitals of Addis Ababa City and Amhara Region, Ethiopia

Abstract

Purpose

Hemodialysis is a renal replacement therapy for end-stage renal disease (ESRD) patients who consume substantial healthcare resources, which increases the economic burden. Plenty of factors affects the cost of hemodialysis treatment, particularly in resource-limited settings. Moreover, the demand for hemodialysis may decrease as the cost increases, but there is limited evidence in Ethiopia. Thus, this study aimed to estimate the cost of hemodialysis treatment among ESRD patients in the tertiary hospitals of Addis Ababa City and Amhara region, Ethiopia.

Patients and Methods

An institutional-based cross-sectional study was conducted among 172 ESRD patients undergoing hemodialysis treatment. A structured questionnaire and patients’ medical chart were used to estimate the costs, and the human capital approach was applied to calculate the indirect costs. A generalized linear model (GLM) was fitted after the modified park test to identify the associated factors. In the final GLM, a p-value of <0.05 and a 95% CI were used to declare the significant variables.

Results

The mean annual cost of hemodialysis treatment was 121,089.27ETB ($4466.59) ± 33,244.99 ($1226.29). The direct and indirect costs covered 77.0% and 23.0% of the total costs, respectively. Age (ex(b): 1.01, p-value <0.001), highest wealth status (ex(b): 1.09, p-value: 0.008), eight (ex(b): 1.27, p-value <0.001) and 12 visits/month (ex(b): 1.34, p-value <0.001), anemia (ex(b): 1.13, p-value <0.001), and comorbidity (ex(b): 1.09, p-value: 0.039) were the factors associated with the costs of hemodialysis treatment.

Conclusion

The annual cost of hemodialysis treatment among ESRD patients was high compared to the national per capita health expenditure, and two-thirds covered by the direct medical costs. Old age, high wealth status, more visits, anemia, and comorbidity were factors associated with the costs of hemodialysis. Therefore, the healthcare system must make a great effort for cost reduction and reduce the patients with kidney disease before they reach end-stages.

Keywords:

• burden of ESRD
• direct costs
• indirect costs
• GLM
• hemodialysis
• Ethiopia

Data Sharing Statements

All the data supporting the findings are within the manuscript. Additional detailed information and raw data are available from the corresponding author on reasonable request.

Acknowledgments

We are very grateful to the Institute of Public Health, University of Gondar, and all the Chief Executive Officers (CEO) of the five hospitals for their cooperation. We would also like to thank all the urology units’ coordinators and all of the study participants who participated in this study. Our appreciation also goes to the data collectors and supervisors for their unreserved contribution.

Author Contributions

All authors substantially contributed to the design, acquisition, analysis and interpretation of data, drafting, revising and final approval. Besides, all authors agreed to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.