Abstract
Kidney transplantation (KT) is only viable renal replacement option for most patients in India. Most patients do not have health insurance and meet treatment expenditure from their own resources. We prospectively evaluated the expenses associated with KT and its impact on the socioeconomic status of families in a public hospital. All direct and indirect expenses incurred by the patients from the time of diagnosis of chronic kidney disease to KT were recorded. Direct expenses included physician fees, cost of drugs and disposables, dialysis, and expenses on investigations and hospitalization. Indirect expenses included travel, food, stay, and loss of income suffered by the family. Educational dropout and financial loss were also recorded. There were 43 males and 7 females between the ages of 12 and 57 years. Direct expenses ranged from US$ 2,151–23,792 and accounted for two-thirds of the total expenses. Pre-referral hospitalization, dialysis and medication accounted for majority of direct expense. Indirect expenses ranged from US$ 226–15,283. Travel expenses and loss of income accounted for most of indirect expense. About 54%, 8%, and 10% of families suffered from severe, moderate, and some financial crisis respectively. A total of 38 families had job losses, and 1 patient and 12 caregivers dropped out of studies. To conclude, KT is associated with catastrophic out-of-pocket expenditure and pushes a majority of the patients who come for treatment to public hospitals into severe financial crisis. Educational dropout and loss of jobs are other major concerns. Systematic efforts are required to address these issues.
Highlights
The cost incurred on treatment of end-stage renal disease (ESRD) is an important contributor to national health-related expenditure [1,2]
Ethics Statement The study protocol was approved by the Postgraduate Institute of Medical Education and Research (PGIMER) Institute Ethics Committee, and all subjects provided written consent
In the case of the sole minor subject, the father provided written consent. This prospective observational study was done on 50 consecutive patients who presented to the Nehru Hospital, PGIMER, Chandigarh for getting a kidney transplant between March and September 2011
Summary
The cost incurred on treatment of end-stage renal disease (ESRD) is an important contributor to national health-related expenditure [1,2]. As hemodialysis is not widely available, living related donor transplantation soon after the diagnosis is the only viable form of long-term RRT for most patients. The poor typically seek treatment in public sector hospitals where the government subsidizes treatment. They do not have to pay for medical advice, procedures, and investigations but must pay for drugs and disposables. Lack of a system of referral forces patients to travel long distances, often with multiple family members to seek out transplant facilities [6]. This entails expenses on travel, food and housing. Loss of job and interruption of education of patients and family members are additional sources of revenue loss
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