Cost estimate of chronic hemodialysis in Kinshasa, the Democratic Republic of the Congo: A prospective study in two centers

Patrick P. M. IZEIDI,1 Yannick M. NLANDU,2 François B. LEPIRA,2Jean-Robert R. MAKULO,2 Yannick M. ENGOLE,2 Vieux M. MOKOLI,2Justine B. BUKABAU,2 Fulbert N. KWILU,3 Nazaire M. NSEKA2, Ernest K. SUMAILI2 ,1Dialysis Unit, General Hospital of Kinshasa, 2Nephrology Unit,

1Department of Internal Medicine, Faculty of Medicine, 2Kinshasa University Hospital, University of Kinshasa and 3Kinshasa School of Public Health,
University of Kinshasa, Kinshasa, Democratic Republic of the Congo


Background: The number of patients on dialysis has significantly increased worldwide. However, prospective studies estimating the cost of hemodialysis (HD) in sub-Saharan Africa remain scarce.
The present study aimed to evaluate the direct cost of treating end stage renal disease. Determinants of additional direct cost were also assessed.

Methods : This study is an analytical, prospective study of cost performed at two HD centers in Kinshasa for a period of 3 months among HD patients enrolled consecutively. The cost analyzed includes only expenditures: consultation, HD session, drugs, comorbidities, laboratory tests, and imaging. Transportation, patient hospitalization, and indirect costs are not taken into account. The determinants of the additional direct cost of HD are identified by multivariate logistic regression
analysis. P < 0.05 is the level of statistical significance.
Findings : The average quarterly direct cost of chronic HD in United States Dollars (US$) is $7070 (~US$28,280 annual cost) at a rate of US$287 per patient per HD session. This cost includes the HD session (US$237) and medicine (US$33) costs, which account for 82.5% and 11.3% of the direct costs, respectively. The presence of at least 4 comorbidities (OR adjusted 4.3, 95% CI [1.23–14.95], P = 0.022) and infection (adjusted OR 4.56, 95% CI [1.05–19.85], P = 0.043) emerged as independent
determinants of additional direct cost.
Conclusion : The direct cost of HD is very high in Kinshasa, where more than 80% of Congolese people live on less than US$1.25 a day.
Keywords : Direct cost, hemodialysis, quarterly follow-up, Kinshasa, economic evaluation

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