Comparative Assessment of Out-of-Pocket Health Expenditure in Haemodialysis and Peritoneal Dialysis Patients.

Background

Dialysis is a life-sustaining treatment for patients with end-stage renal disease (ESRD), but it requires high financial costs due to the need for continuous treatment and the associated expenses of medical supplies, equipment, and related care.

Objective

This study aims to compare the out-of-pocket (OOP) health expenditure incurred by patients undergoing haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD).

Methods

The data for this observational cross-sectional study were obtained through a survey at two public hospitals, comprising a sample of 220 ESRD patients. In order to compare the OOP health expenditure between two modalities, the Mann-Whitney U test and the chi-square test were employed. Multiple linear-regression analysis was then used to identify the contributing factors associated with the aforementioned OOP expenses.

Results

The estimated median monthly OOP health expenditure for HD patients was MYR 388 (interquartile range [IQR: 224-519]), significantly higher than CAPD (MYR 160 [IQR: 100-231]; p < 0.001). Our findings confirm that the choice of dialysis modality significantly affects the OOP health expenditures for dialysis patients MYR 145.73; 95% CI: 75.51-218.15; p < 0.05; 0.001. Additional determinants of OOP health expenditure identified in this study include the interaction between the modality choice and the distance from home to the dialysis centre (MYR 3.39; 95% CI: 0.27-6.66; p < 0.05; 0.022), comorbidity status (MYR 49.51; 95% CI: 9.09-90.77; p < 0.05; 0.031), duration of illness (MYR 4.01; 95% CI: 0.71-7.63; p < 0.05; 0.041), and household income MYR 67.43 (95% CI: 1.71-134.81; p < 0.05; 0.021).

Conclusions

This study emphasises the need to improve the training and awareness of CAPD to increase its use, as it requires less travel and lowers OOP expenses. In addition, introducing a travel reimbursement scheme is also recommended to reduce the transportation costs for HD patients.