Out-of-pocket payments of End-stage Renal Disease Patients on Regular Hemodialysis: Cost of illness analysis, Experience from Sudan

Background: In Sudan, the number of End Stage Renal Disease (ESRD) patients receiving hemodialysis is growing. Patients and their families incur a high out of pocket expenditure provided that hemodialysis treatment is expensive. There is limited data about out of pocket spending on hemodialysis in the country. This study aims to explore patients’ out-of-pocket expense on direct medical and non-medical goods and services and to which extent they can be predicted from socio-demographic characteristics, health insurance status, comorbidity, and accommodation change. Methods This is a cross-sectional descriptive study conducted in Ibn Sina Hospital. One hundred and thirty patients undergo regular two hemodialysis sessions were randomly selected. Results Among the study participants the median of the overall total out-of-pocket (direct medical and direct non- medical) spending per patient per year was found to be US$ 3859.1(Inter quartile Range(IQR): 2298.1- 6261.1). As for the medians out-of-pocket expenditure on direct medical and non-medical costs, they were found to be US$2327.6 (IQR 1421.5-3804.8) and US$ 1096 (IQR 715.2-2345.2), respectively. The direct medical expenditure (355586US$) accounted for (60%) of the overall total expenses. Medications and investigations were the primary drivers of direct medical spending. Higher out-of-pocket expenditure rates were found among those with one or more of these merits; uninsured patients, Patient with comorbidity, female gender, and over 40 years age. The multivariate analysis showed that the significant predictors of direct medical expenditure were health insurance, comorbid conditions, while the predictors for direct non-medical expenditure were accommodation change and gender. Conclusion Results of this study provide a better understanding of out-of-pocket spending on direct medical and non-medial spending among hemodialysis patients within the context of Sudan. Furthermore, it provides descriptive information on patients’ characteristics that are found to be associated with increased out of pocket expenditure among hemodialysis population. Further research needed in this area.