Out-of-pocket expenditures, catastrophic household finances, and quality of life among hemodialysis patients in Kerala, India.

Abstract

Kidney replacement therapy in chronic kidney disease patients can result in catastrophic health costs, pushing them into poverty in lower middle-income countries. There are only limited studies from India focusing on the financial hardship of these patients. Data on direct nonmedical and indirect cost of hemodialysis (HD) are also limited. This study aims to find the different components of cost for HD and its association with quality of life (QOL) among HD patients. Primary objective was to find the cost of HD, which include direct medical, direct nonmedical and indirect cost. Secondary objective was to study whether the ratio of out-of-pocket (OOP) payments for HD to household income can affect the QOL. The QOL was assessed using EQ-5D-5L instrument. Catastrophic health care expenditure was defined as OOP health care expenditure exceeding 40% of the household income and distress financing as borrowing money or selling assets to meet the OOP expenditure for treatment. Of the 152 patients enrolled for the study, 103 (67.8%) were males. Mean age was 60.9 ± 12.5 years. Monthly OOP expenditure for dialysis was USD 478.4 (362.6-663.6) of which direct nonmedical and indirect expenses constitute USD 115.6 (88.4-292.4). Median percentage of household income spent for dialysis was 194.5 (IQR 128-297). One hundred and forty-two (93.4%) had catastrophic healthcare expenditure and 76 (50%) had distressing health care expenditure. On multivariable linear regression, proportion of total household income spend for dialysis was associated with poor QOL in patients undergoing HD; coefficient=-0.04 (95% CI -0.008 - 0.092), p=0.039. Nonmedical direct and indirect cost is substantial among patients undergoing HD. Nine of 10 patients had catastrophic health care expenditure, which pushed 50% of the patients to distress financing.