Out-of-pocket expenditure and financial risks associated with treatment of chronic kidney disease in Ethiopia: a prospective cohort costing analysis

Area of Science:

• Public Health
• Health Economics
• Nephrology

Background:

• Ethiopia faces a growing burden of kidney disease (KD), a major public health challenge.
• Most healthcare expenditures in Ethiopia are paid out-of-pocket (OOP).
• Chronic kidney disease (CKD) poses a significant economic burden in low- and middle-income countries.

Purpose of the Study:

• To quantify out-of-pocket (OOP) health expenditures for chronic kidney disease (CKD) care in Ethiopia.
• To assess the magnitude of catastrophic and impoverishing health expenditures (CHE and IHE) associated with CKD.
• To identify drivers of catastrophic health expenditures for CKD patients.

Main Methods:

• Prospective costing analysis from the patient perspective.
• Data collected on OOP health expenditures and household consumption for 433 CKD patients over 6 months.
• Descriptive statistics and logistic regression used to measure CHE, IHE, and their determinants.

Main Results:

• Mean annual OOP expenditure was US$2337, with haemodialysis being the most expensive care (US$5312).
• Direct medical expenditures, particularly for haemodialysis, were the primary cost drivers.
• 36% of outpatient, 67% of inpatient, and 90% of haemodialysis patients incurred catastrophic health expenditures (CHE).
• 25.6% of households experienced impoverishment due to OOP medical costs, rising to 43.4% for haemodialysis patients.

Conclusions:

• The substantial household economic burden of CKD care in Ethiopia hinders treatment access and worsens poverty.
• High rates of CHE and IHE associated with CKD pose a significant barrier to achieving universal health coverage and Sustainable Development Goals in Ethiopia.