Willingness to pay for kidney transplantation among chronic kidney disease patients in Ghana

Abstract

Background Kidney transplantation is the preferred treatment for patients with end stage renal disease. However, it is largely unavailable in many sub-Sahara African countries including Ghana. In Ghana, treatment for end stage renal disease including transplantation, is usually financed out-of-pocket. As efforts continue to be made to expand the kidney transplantation programme in Ghana, it remains unclear whether patients with Chronic Kidney Disease (CKD) would be willing to pay for a kidney transplant. Aim The aim of the study was to assess CKD patients’ willingness to pay for kidney transplantation as a treatment option for end stage renal disease in Ghana. Methods A facility based cross-sectional study conducted at the Renal Outpatient clinic and Dialysis Unit of Korle-Bu Teaching Hospital among 342 CKD patients 18 years and above including those receiving haemodialysis. A consecutive sampling approach was used to recruit patients. Structured questionnaires were administered to obtain information on demographic, socio-economic, knowledge about transplant, perception of transplantation and willingness to pay for transplant. In addition, the INSPIRIT questionnaire was used to assess patients’ level of religiosity and spirituality. Contingent valuation method (CVM) method was used to assess willingness to pay (WTP) for kidney transplantation. Logistic regression model was used to determine the significant predictors of WTP. Results The average age of respondents was 50.2 ± 17.1 years with most (56.7% (194/342) being male. Overall, 90 out of the 342 study participants (26.3%, 95%CI: 21.7–31.3%) were willing to pay for a kidney transplant at the current going price (≥ $ 17,550) or more. The median amount participants were willing to pay below the current price was $986 (IQR: $197 –$1972). Among those willing to accept (67.3%, 230/342), 29.1% (67/230) were willing to pay for kidney transplant at the prevailing price. Wealth quintile, social support in terms of number of family friends one could talk to about personal issues and number of family members one can call on for help were the only factors identified to be significantly predictive of willingness to pay (p-value < 0.05). Conclusion The overall willingness to pay for kidney transplant is low among chronic kidney disease patients attending Korle-Bu Teaching Hospital. Patients with higher socio-economic status and those with more family members one can call on for help were more likely to pay for kidney transplantation. The study’s findings give policy makers an understanding of CKD patients circumstances regarding affordability of the medical management of CKD including kidney transplantation. This can help develop pricing models to attain an ideal poise between a cost effective but sustainable kidney transplant programme and improve patient access to this ultimate treatment option.

A Scoping Review of Kidney Transplantation in Africa: How Far have We Come?

“…The cost of renal transplant in Africa varies largely among different countries, this averages about $17,550. Most of this cost is paid for out of pocket by the patients [45]. The main findings of the review indicate that kidney transplantation in Africa is still in its early stages of development, with low rates of transplantation compared to other regions of the world [46].…”

Healthcare Seeking Behaviour of Patients with Chronic Kidney Disease in the Tamale Teaching Hospital, Ghana

“…The situation in Africa regarding the incidence of CKD is not different [7]. The prevalence of kidney disease in the general population in Africa is 15.8% with 36.1% of highrisk persons having the disease [8][9][10]. This is projected to put pressure on health infrastructure if the right measures are not put in place to check the trend [11].…”

Willingness of caregivers to donate a kidney to a patient with end-stage renal disease: Findings from four dialysis providing health facilities in Uganda

“…Prior studies indicate that patients with ESRD are willing to accept kidney transplants provided they receive information on kidney transplantation, and if they perceive that a living person can donate a kidney, and also if they are convinced that the transplant would improve the quality of life [5]. More than a quarter of patients with ESRD are willing to pay for a kidney transplant particularly those in the high wealth quintile and or those with social support from family members and friends [6].…”