Myanmar Health Sciences Research Journal
Original Articles :
Myanamr Health Research Registration 2022; 34(1-3): 18-25.
DOI:

Cost Estimation of Hemodialysis among Patients with Chronic Kidney Disease in 500-Bedded Yangon Speciality Hospital

Thandar Tun*, Yadanar & Kyaw Swa Mya

Myanmar Health Sciences Research Journal, Vol. 34, No. 1-3, 2022

ABSTRACT

Chronic Kidney Disease (CKD) is an important cause of death and loss of disability-adjusted-life-years worldwide. Every stage of CKD management imposes a substantial financial burden on the health system, and patients and their households by increasing out-of-pocket payments.  The objectives of the study were to estimate the direct and indirect cost, and to explore the coping methods of patients with CKD in 500-bedded Yangon Speciality Hospital. Hospital-based, cross-sectional descriptive study was conducted among 55 adult dialysis patients who had registered for more than one month at the Out-Patient Department
of the Renal Medical Unit. Data were collected by pre-tested semi-structured face-to-face interview questionnaire and reviewing vouchers and medical records. The median value of monthly out-of-pocket expenditure on hemodialysis was 594,000 Myanmar Kyat
(MMK), in which 476,200 MMK cost for direct-medical, 81,000 MMK for direct non-medical and 80,000 MMK for indirect expenditures. One-unit cost for hemodialysis was highest 53,750 MMK at a private hospital and lowest 12,000 MMK at a charitable hospital. Meal and transportation cost 12,000 MMK and 28,000 MMK per month. Sixteen attendances lost their wages about 72,000 MMK per month. The most common coping methods were using income (96%) and selling assets (71%). Public hospital can support dialysis only once a week for a registered patient. All patients have to seek care from the private and charitable hospital that increase the treatment cost for that chronic disease. Hence, the government should provide more new renal dialysis centers and should establish a sound financial protection mechanism.


RESULT
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INTRODUCTION
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Chronic Kidney Disease (CKD) is one of the significant drivers of health-related expen- diture and one of the growing challenges among non-communicable diseases (NCDs) for the health system.1 The number of patients with CKD is expected to grow at the fastest rate in the poorest part of the world. The low economic level contributes to less availability of dialysis.2 The burden of CKD is underestimated globally although it is emerging as  a major public health  problem.
The costs of renal replacement therapy (RRT) are high and health care budgets are out of reach for developing countries.
3 Estimation of the treatment costs for CKD increases as the disease severity worsens.


SUPPLEMENTARY MATERIAL
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It was a hospital-based cross-sectional des-criptive study conducted from 1st September 2017 to 30th June 2018 among hemodialysis patients registered at the Out-Patient Department (OPD) of Renal Medical Unit
at 500-bedded Yangon Speciality Hospital.
In this study, Yangon Region is purposively selected because it is a city equipped with highly facilitated tertiary hospitals. Among five public dialysis centers in Yangon, the 500-bedded Yangon Speciality Hospital was chosen because it is only one hospital for specialty care with full capacity.

Patients of age more than 18 years and who undergo hemodialysis for more than one month were eligible for this study.
DISCUSSION
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The total health care expenditure was estimated from 55 hemodialysis patients and explored how they used to overcome their burdens. The majority of hemodialysis patients were 40-59 years of the productive working-age population and about three-fourth were previously employed. More than one-third of the respondents’ families had only one income earner and even there were certain proportion of households with no income earner. This factor reflected the unaffordability to the treatment they need. Most of the respondents came to the hospital with their family members.


ACKNOWLEDGMENT
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This study was supported by the grant from the Department of Medical Research, Yangon, Myanmar (2017). We are grateful to the persons; Professor Khay Mar Mya, Rector of University of Public Health, Yangon,
Dr. Than Htut, Senior Medical Super-intendent, 500-Bedded Yangon Speciality Hospital, Dr. Khin Thida Thwin (Professor and Head, Department of Renal Medical Unit, 500-Bedded Yangon Speciality Hospital) who kindly allowed us to conduct this study and gave us very useful information. A special appreciation must go to all hemodialysis patients and their family members.


CONFLICT OF INTEREST
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The authors declare that they have no competing interests.


REFERENCES
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