Introduction
In Ethiopia, most healthcare expenditures are paid out-of-pocket (OOP), while the burden of kidney disease (KD) is rapidly increasing, posing a major public health challenge in low- and middle-income countries, along with a staggering economic burden. We aimed to quantify the extent of OOP health expenditures and the magnitude of associated catastrophic and impoverishing health
... [Show full abstract] expenditures (CHE and IHE) for chronic KD (CKD) care in Ethiopia.
Methods
We conducted a prospective costing analysis for CKD care from the patient perspective. We collected data on OOP health expenditures (2023 US2337 (95% CI US2659) and varied by type of care: US511 to US2759 (95% CI US4347) for inpatient care and US4644 to US$5919) for haemodialysis. DMEs (particularly haemodialysis) were the major drivers of cost, accounting for 76%–85% of the total OOP expenditure. Transportation expenditures were the major contributors among the DNMEs. Among those who sought outpatient, inpatient and haemodialysis care, 36%, 67% and 90% incurred CHE, respectively, at a 10% threshold of annual consumption expenditures. Among all patients, 25.6% of households were impoverished due to OOP medical expenditures, with the rate substantially higher among those requiring haemodialysis (43.4%). Facility type and the type of visit were significantly associated with the odds of incurring CHE (p<0.05), while adjusting for wealth quintile, disease stage, area of residence (urban/rural), family size, patient age and insurance membership status.
Conclusions
The household economic burden for CKD care is substantial, likely hindering access to necessary treatment and exacerbating the impoverishment, which is prevalent in Ethiopia. This would be an obstacle in achieving universal health coverage and Sustainable Development Goals in Ethiopia.