Economic Impact of Dialysis on Household Welfare in Buea and Bamenda, Cameroon

Abstract

Background: Noncommunicable diseases, such as kidney failure, diabetes, and cancer, are among the leading causes of death worldwide. There is a sharp increase in the incidence and prevalence of patients with kidney failure requiring replacement therapy. This has led to a very high cost, especially in resource-limited settings like Cameroon. The aim of this study is to determine the effects of direct and indirect costs of kidney failure treatment on household welfare. Methods: A descriptive cross-sectional study was conducted between May and July 2022 among 133 chronic hemodialysis patients at the Buea and Bamenda Regional Hospitals. Participants were selected through stratified purposive sampling. A pre-tested questionnaire, adapted from the WHO’s economic impact tool for chronic disease, was used to collect data on direct costs (consultations, diagnostics, medications, and dialysis fees) and indirect costs (transportation, accommodation, and caregiver time). Data were analyzed using Stata version 14. Descriptive statistics were used for baseline characteristics, while Ordinary Least Squares (OLS) and multivariate linear regression analyses were employed to explore associations between treatment costs and household expenditure. Statistical significance was set at p < 0.05. Results: The mean age of participants was 44.6 ± 15.5 years, with 60.2% male and 62.4% married. Most (59.4%) were unemployed, and 60.9% paid out-of-pocket, as none had health insurance. The annual household expenditure ranged from $488.38 to $5,469.83 (mean = $2,519.59), while the total annual cost of treatment ranged from $793.89 to $15,267.18 (mean = $3,320.00). While total direct and indirect treatment costs showed negative but non-significant associations with household expenditure, disaggregated analysis revealed important patterns. Consultation and diagnostic test costs had significant negative associations with household expenditure (β = -0.293, p = 0.001 and β = -0.358, p < 0.001), which implies that as spending on these items increased, overall household expenditure decreased due to a resource crowding-out effect. Conversely, spending on medications and self-medication had significant positive associations (β = 0.189, p = 0.028 and β = 0.327, p < 0.001), indicating a direct increase in financial burden and a corresponding reduction in household welfare. Conclusion: Kidney failure has a significant negative effect on the household welfare of patients on dialysis. Health insurance schemes and universal health coverage should target patients on hemodialysis. Universal health coverage in Cameroon should aim to specifically cover the cost of consultation, laboratory tests, medications, and transportation for dialysis patients in these regions.