Patient costs of diabetes mellitus care in public health care facilities in Kenya


Int J Health Plann Manage

OBJECTIVE: To estimate the direct and indirect costs of diabetes mellitus care at five public health facilities in Kenya. METHODS: We conducted a cross-sectional study in two counties where diabetes patients aged 18 years and above were interviewed. Data on care-seeking costs were obtained from 163 patients seeking diabetes care at five public facilities using the cost-of-illness approach. Medicines and user charges were classified as direct health care costs while expenses on transport, food, and accommodation were classified as direct non-health care costs. Productivity losses due to diabetes were classified as indirect costs. We computed annual direct and indirect costs borne by these patients. RESULTS: More than half (57.7%) of sampled patients had hypertension comorbidity. Overall, the mean annual direct patient cost was KES 53 907 (95% CI, 43 625.4-64 188.6) (US$ 528.5 [95% CI, 427.7-629.3]). Medicines accounted for 52.4%, transport 22.6%, user charges 17.5%, and food 7.5% of total direct costs. Overall mean annual indirect cost was KES 23 174 (95% CI, 20 910-25 438.8) (US$ 227.2 [95% CI, 205-249.4]). Patients reporting hypertension comorbidity incurred higher costs compared with diabetes-only patients. The incidence of catastrophic costs was 63.1% (95% CI, 55.7-70.7) and increased to 75.4% (95% CI, 68.3-82.1) when transport costs were included. CONCLUSION: There are substantial direct and indirect costs borne by diabetic patients in seeking care from public facilities in Kenya. High incidence of catastrophic costs suggests diabetes services are unaffordable to majority of diabetic patients and illustrate the urgent need to improve financial risk protection to ensure access to care.

Oyando, R., Njoroge, M., Nguhiu, P., Sigilai, A., Kirui, F., Mbui, J., Bukania, Z., Obala, A., Munge, K., Etyang, A., Barasa, E.

Pages:290-308, Volume:35, Edition:10/18/2019, Date,Jan


Notes:Oyando, Robinson|Njoroge, Martin|Nguhiu, Peter|Sigilai, Antipa|Kirui, Fredrick|Mbui, Jane|Bukania, Zipporah|Obala, Andrew|Munge, Kenneth|Etyang, Anthony|Barasa, Edwine|eng|KEMRI IRG-04/KEMRI Internal Research Grant|214622/Wellcome TrustInternational Master’s Fellowship|092654/Wellcome Trust core grant|107527/Research Training Fellowship|England|2019/10/18 06:00|Int J Health Plann Manage. 2020 Jan;35(1):290-308. doi: 10.1002/hpm.2905. Epub 2019 Oct 17.

ISBN: 1099-1751 (Electronic)|0749-6753 (Linking) Permanent ID: PMC7043382 Accession Number: 31621953

Author Address: Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.|Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.|Centre for Geographic Medicine Research, Kenya Medical Research Institute, KiIifi, Kenya.|Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.|Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya.|Medical Microbiology, Moi University, Eldoret, Kenya.|Nuffield Department of Medicine, University of Oxford, Oxford, UK.