The cost of dialysis in low and middle-income countries: a systematic review

Abstract

BackgroundThe cost of dialysis in low and middle-Income countries has not been systematically reviewed. The objective of this article is to systematically review peer-reviewed articles on the cost of dialysis across low and middle-income countries.MethodsPubMed and Embase databases were searched for the year 1998 to March 2013, and additional studies were added from Google Scholar search. An article was included if two reviewers agreed that it had reported cost of dialysis from low and middle-Income countries.ResultsThe annual cost per patient for hemodialysis (HD) ranged from Int$ 3,424 to Int$ 42,785, and peritoneal dialysis (PD) ranged from Int$ 7,974 to Int$ 47,971. Direct medical cost especially drugs and consumables for HD and dialysis solutions and tubing for PD were the main cost drivers.ConclusionThe number of studies on the economics of dialysis in low and middle-income countries is limited. Few papers indicate that dialysis is an expensive form of treatment for the population of these countries and that the poorer countries have an over-proportional burden to finance dialysis services. Further research is needed to determine the cost of dialysis based on a standard methodology grounded on existing economic guidelines and to address the question whether dialysis should be an element of the essential package of health in resource-poor countries. Used data should be as complete as possible. In case of missing data, proxies can be used. In case of developing countries, expert interviews are often used for estimating missing information.

Challenges and outcomes of haemodialysis among patients presenting with kidney diseases in Dodoma, Tanzania

“…Patients who were not on NHIF scheme had higher odds of poor outcomes. This finding is similar to other studies; a study conducted between 1998 and 2013 showed that haemodialysis in low and middle-income countries were faced with severe financial barriers to access dialysis services and dialysis patients could not afford dialysis on the free market [8, 18]. Studies from Nigeria and Sub Saharan Africa reported that many patients were unable to pay for the recommended adequate dialysis owing to high costs; only 6.8% of patients were able to afford haemodialysis beyond 3 months [12–14].…”

Carga laboral de las enfermeras en Unidades de Hemodiálisis Crónica según dependencia y riesgo de los pacientes

“…En particular se requiere que la enfermera tenga habilidades interpersonales, competencias técnicas y clínicas para otorgar una atención segura y de calidad 5 . El personal de enfermería representa cerca del 45% de la fuerza de trabajo de una Unidad de Hemodiálisis (UHD), siendo parte de los costos directos de la diálisis 6,7 . Determinar la dotación de enfermeras para garantizar la seguridad del paciente sigue siendo una decisión importante que deben tomar los administradores de salud 8 .…”

Cost estimate of chronic hemodialysis in Kinshasa, the Democratic Republic of the Congo: A prospective study in two centers

“…15 It is estimated at an average annual cost in Euros (€) of 50,000 per patient per year and €81,500 per patient per year, respectively, for peritoneal dialysis and HD in central Europe. 17,18 It is slowly starting to be subsidized by the state at varying proportions in many countries such as Cameroon, Kenya, Sudan, and others. 1 The consequences are huge and in addition to trauma related to lack of preparation for treatment initiation.…”

“…16 In SSA, CKD diagnosis usually occurs late in advanced stages requiring urgent RRT management. 18 In the Democratic Republic of the Congo (DRC), a low-income country with a gross domestic product per capita of US$271 and annual health expenditures of US $15 per capita, 19 CKD prevalence is 12.4% in Kinshasa, and 0.2% have ESRD. Complications installed during the disease's silent phase severely burden patients' future and treatment cost.…”

“…The presence of at least 4 comorbidities (OR adjusted 4.3, 95% CI [1.23-14.95], P = 0.022) and infection (adjusted OR 4.56, 95% CI [1. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].85], P = 0.043) emerged as independent determinants of additional direct cost.…”