Patient costs of diabetes mellitus care in public health care facilities in Kenya

Abstract

Objective: To estimate the direct and indirect costs of diabetes mellitus care at five public health facilities in Kenya. Methods:We conducted a cross-sectional study in two counties where diabetes patients aged 18 years and above were interviewed. Data on care-seeking costs were obtained from 163 patients seeking diabetes care at five public facilities using the cost-of-illness approach. Medicines and user charges were classified as direct health care costs while expenses on transport, food, and accommodation were classified as direct non-health care costs. Productivity losses due to diabetes were classified as indirect costs. We computed annual direct and indirect costs borne by these patients. Results: More than half (57.7%) of sampled patients had hypertension comorbidity. Overall, the mean annual direct patient cost was KES 53 907 (95% CI, 43 625.4-64 188.6) (US$ 528.5 [95% CI, 427.7-629.3]). Medicines accounted for 52.4%, transport 22.6%, user charges 17.5%, and food 7.5% of total direct costs. Overall mean annual indirect cost was KES 23 174 (95% CI, 20 910-25 438.8) (US$ 227.2 [95% CI, 205-249.4]). Patients reporting hypertension comorbidity incurred higher costs compared with diabetes---This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Int J Health Plann Mgmt. 2020;35:290-308. wileyonlinelibrary.com/journal/hpm 290 only patients. The incidence of catastrophic costs was 63.1% (95% CI, 55.7-70.7) and increased to 75.4% (95% CI, 68.3-82.1) when transport costs were included. Conclusion: There are substantial direct and indirect costs borne by diabetic patients in seeking care from public facilities in Kenya. High incidence of catastrophic costs suggests diabetes services are unaffordable to majority of diabetic patients and illustrate the urgent need to improve financial risk protection to ensure access to care.

Cost of illness of type 2 diabetes mellitus from the patient’s perspective: a study from several primary healthcare centres and a hospital in Yogyakarta, Indonesia

“…Most of the respondents who were T2DM patients were female. This inding was similar to the study conducted in public health facilities in Kenya in which the majority (Oyando et al, 2020). According to the previous study in Nigeria, it was mentioned that man was more active thank woman hence might stimulate sensitivity of insulin, and those physical activities were related to DM disease (Ekpenyong et al, 2012).…”

“…This indicated the T2DM patients visiting the hospital had a longer duration of disease and might also more severe. Most of the patients of T2DM in Kenya had a duration of disease >5 years (47.9%) (Oyando et al, 2020). In contrary, T2DM patients from another study at a hospital in Thailand was the majority had the duration of disease between 1 -5 years (55.6%) (Chatterjee et al, 2011).…”

“…Data of patients' characteristics as well as data of costs based on their categories and components, were analyzed using descriptive analysis. The productivity lost was measured using a human capital approach with following calculation methods: the number of days lost of patients and their caregivers due to patients' treatment was multiplied by the amount of daily wage based on real income (Oyando et al, 2020). Costs were presented as cost per patient per certain period (3 months), cost per visit, and unit cost per cost components.…”

The Current Situation Regarding Long-Acting Insulin Analogues Including Biosimilars Among African, Asian, European, and South American Countries; Findings and Implications for the Future

“…Key concerns and challenges include a lack of diagnosis, issues of management exacerbated by affordability problems as well as control of symptoms. These issues and concerns have resulted in a number of initiatives in recent years ( 69 , 70 , 120 ). These include the Base of Pyramid (BoP) project, with a ceiling price of KSh 500–600 (US$5-6) for insulin Mixtard® insulin to help address affordability concerns.…”

“…Consequently, there has been very variable availability and use of long-acting insulin analogues in Kenya in recent years. This includes the leading tertiary hospital in Kenya—Kenyatta National Hospital (KNH), a level six hospital ( 120 )—where there has been an increasing use of long-acting insulin analogues in recent years; however from a low base. Utilisation of insulin glargine rose from 0.51% of total insulins (DDD basis) in 2015 to currently 3.4–3.6% of total insulin use (DDD basis).…”