The monetary cost of delays in kidney transplantation in a public health facility in a developing country: Kenyan experience
John Ngigi1, Gilbert kokwaro2, Samuel Kabinga3.
1 Nephrology , Kenyatta National Hospital, Nairobi, Kenya; 2Strathmore Business school, Strathmore University, Nairobi, Kenya; 3East Africa Kidney Institute, University of Nairobi, Nairobi, Kenya
Introduction: Kidney transplantation is the preferred choice of treatment for end stage kidney disease (ESKD) as it confers the recipients with better quality of life when compared with other modalities of kidney replacement therapy (KRT). The economic benefits of kidney transplantation are also superior when compared with either dialysis or conservative treatments respectively.In living kidney donations, the pre-transplant evaluation involves sequenced processes all aimed at optimizing resources to deliver a kidney transplant within the shortest time. The shortest period of a donor-recipient pair evaluation within our transplant program is three (3)months. Delays in operation for a kidney transplant attracts both direct and indirect costs with the most unavoidable being the direct cost of continued dialysis.
Methods: We set up a study to establish duration of delays in certain processes with the pre-transplant evaluation for donor-recipient pairs from which we could calculate the direct cost of continued hemodialysis (HD) using a twice weekly HD model at approximately 80 USD per session as the amount at which the social insurance reimburses for HD. We considered three (3) months as the optimum and the economic-neutral duration. This was an observational retrospective study conducted at the Kenyatta National Hospital in Kenya over a five-year period between 2010 to 2014. The captured data were analysed using Statistical Package for the Social Science version 20.0. For categorical data, frequencies were calculated as numbers and percentages while for numerical data, the means and standard deviations were calculated when normally distributed while the medians and interquartile ranges were calculated for skewed data.
Results: A total of 99 donor-recipient pairs who had undergone pre-transplant evaluation between 2007 – 2014 and underwent transplantation during the study period were included.The mean age was 37±13 years. Males were 73(73.7%). Sixty two (62.6%) were married and sixty five (65.7%) were in informal self-employment. The median duration taken in the kidney transplant evaluation process was 10 months (IQR 5 – 13). Only six (6) donor-recipient pairs (6.3%) were evaluated within three (3) months period. The remaining 93(93.7%) were evaluated for between four (4) and 84 months. This translated to 891 HD-months within which 7,128 sessions of HD were purchased by the social insurer. At a cost of USD 80 per HD session, this translated to USD 570,240 as being the direct cost required to maintain the patients on HD during the delayed period.
Conclusion: The time taken to go through the pre-transplant evaluation process within our program is long with the cost of maintaining patients on HD presenting an enormous opportunity cost which can be reduced significantly if the pre-evaluation period is shortened to three months.
Keywords: End stage kidney disease, kidney transplantation, Cost, hemodialysis.
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