School of Public Administration and Management (SOPAM)

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Author: search.filters.author.Mushi, LawrenciaSubject: search.filters.subject.Hemodialysis

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    Cost of dialysis in Tanzania: Evidence from the provider’s perspective
    (Health Economics Review, 2015) Mushi, Lawrencia; Krohn, Markus; Flessa, Steffen
    Background: Although End Stage Renal Disease (ESRD) is a disease of increasing epidemiological relevance very little is known about the cost of providing the respective dialysis services in Tanzania. This paper estimates the costs of dialysis for ESRD patients at Muhimbili National Hospital (MNH) in Tanzania in the year 2014. Methods: Cost calculations are based on the provider's perspective and include only the direct cost of dialysis treatment. The cost of drugs and consumables was obtained from the price list issued by the Medical Stores Department (MSD) in Tanzania. Additional data were collected through face-to-face interviews with experts at the dialysis unit. Results: MNH performs on average 442 hemodialysis per month (34 patients, with three sessions per week) with a personnel placement of 20 nurses, four nephrologists, eight registrars, one nutritionist, two biomedical engineers, four health attendants and nine dialysis machines. The respective average unit cost per hemodialysis is 176 US$. Consequently, an average patient requiring three dialyses per week (i.e. 156 dialyses per year) will incur annual costs of 27,440 US$. Conclusion: The cost of dialysis is enormous for a least-developed country like Tanzania where resources and technology are rather limited. Thus, from the economic point of view, it seems rational to allocate health care budgets towards curable diseases, which have a higher cost-effectiveness and cater for the majority of the population. However, before a final decision on allocation of budgets towards dialysis is made all efforts must be invested to improve technical efficiency by cutting the enormous unit cost.
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    The cost of dialysis in low and middle income countries: A systematic review
    (BMC Health Services Research, 2015) Mushi, Lawrencia; Marschall, Paul; Fleßa, Steffen
    Background: The cost of dialysis in low and middle-income countries has not been systematically reviewed. The objective of this article is to systematically review peer-reviewed articles on the cost of dialysis across low and middle-income countries. Methods: PubMed and Embase databases were searched for the years 1998 to March 2013, and additional studies were added from Google Scholar search. An article was included if two reviewers agreed that it had reported the cost of dialysis from low and middle-income countries. Results: The annual cost per patient for hemodialysis (HD) ranged from Int$ 3,424 to Int$ 42,785, and peritoneal dialysis (PD) ranged from Int$ 7,974 to Int$ 47,971. Direct medical costs especially drugs and consumables for HD and dialysis solutions and tubing for PD were the main cost drivers. Conclusion: The number of studies on the economics of dialysis in low and middle-income countries is limited. Few papers indicate that dialysis is an expensive form of treatment for the population of these countries and that the poorer countries have an over-proportional burden to finance dialysis services. Further research is needed to determine the cost of dialysis based on a standard methodology grounded on existing economic guidelines and to address the question of whether dialysis should be an element of the essential package of health in resource-poor countries. Used data should be as complete as possible. In case of missing data, proxies can be used. In the case of developing countries, expert interviews are often used for estimating missing information.