How are patients managing with the costs of care for chronic kidney disease in Australia? A cross-sectional study

BMC Nephrology

Stephen Jan¹  Qiang Li¹  Jeremy Chapman²  Germaine Wong³  Beverley M Essue¹ 

[1] The George Institute for Global Health, University of Sydney, Missenden Road, PO Box M201, Sydney, NSW, 2050, Australia;Westmead Hospital, Acute Interventional Medicine and Renal Services, Darcy Road, Westmead, Sydney, NSW, 2145, Australia;Children’s Hospital at Westmead, Centre for Kidney Research, Westmead Hospital, The Research Building, Level 2, Sydney, NSW, 2145, Australia

关键词: Australia;    Out-of-pocket costs;    Economic hardship;    Chronic kidney disease;   

Others  :  1083033
DOI  :  10.1186/1471-2369-14-5

 received in 2012-05-28, accepted in 2012-12-21,  发布年份 2013

【 摘 要 】

Background

Chronic kidney disease (CKD) poses a financial burden on patients and their households. This descriptive study measures the prevalence of economic hardship and out-of-pocket costs in an Australian CKD population.

Methods

A cross-sectional study of patients receiving care for CKD (stage III-V) in Western Sydney, Australia using a structured questionnaire. Data collection occurred between November 2010 and April 2011. Multivariate analyses assessed the relationships between economic hardship and individual, household and health system characteristics.

Results

The study included 247 prevalent CKD patients. A mean of AUD$907 per three months was paid out-of-pocket resulting in 71% (n=153) of participants experiencing financial catastrophe (out-of-pocket costs exceeding 10% of household income). Fifty-seven percent (n=140) of households reported economic hardship. The adjusted risk factors that decreased the likelihood of hardship included: home ownership (OR: 0.32, 95% CI: 0.14-0.71), access to financial resources (OR: 0.24, 95% CI: 0.11-0.50) and quality of life (OR: 0.12, 95% CI: 0.02-0.56). The factors that increased the likelihood of hardship included if income was negatively impacted by CKD (OR: 4.80, 95% CI: 2.17-10.62) and concessional status (i.e. receiving government support) (OR: 3.09, 95% CI: 1.38-6.91). Out-of-pocket costs and financial catastrophe were not found to be significantly associated with hardship in this analysis.

Conclusions

This study describes the poorer economic circumstances of households affected by CKD and reinforces the inter-relationships between chronic illness, economic well-being and quality of life for this patient population.

【 授权许可】

   
2013 Essue et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Australian Institute of Health and Welfare: Health care expenditure on chronic kidney disease in Australia. Canberra: AIHW; 2009:117. Cat. no. PHE
• [2]Baboolal K, McEwan P, Sondhi S: The cost of renal dialysis in a UK setting—a multicentre study. Nephrol Dial Transplant 2008, 23:1982-1989.
• [3]Zelmer JL: The economic burden of end-stage renal disease in Canada. Kidney Int 2007, 72:1122-1129.
• [4]Australian Institute of Health and Welfare: Health expenditure Australia: 2010–11. Health and welfare expenditure series no. 47. Cat. no. HWE 56. Canberra: AIHW; 2012.
• [5]Australian Institute of Health and Welfare: Dialysis and kidney transplantation in Australia: 1991–2010. Canberra: AIHW; 2012. Cat. no. PHE 162
• [6]Healthcare Management Advisors Pty Ltd and Victorian Department of Human Services: Renal Dialysis Costing and Funding Review. Draft Final Report. Collingwood: Healthcare Management Advisors Pty Ltd; 2006. Available from: http://docs.health.vic.gov.au/docs/doc/B287F4FEF5FE63ECCA2578E20006ACFA/ webcite$FILE/renal-cost-finrep-draft12dec.pdf [cited: 11 December 2011
• [7]Muehrer RJ, Schatell D, Witten B: Factors affecting employment at initiation of dialysis. Clin J Am Soc Nephrol 2011, 6:489-496.
• [8]Alexander GC, Casalino LP, Meltzer DO: Patient-physician communication about out-of-pocket costs. JAMA. 2003, 290:953-958.
• [9]Essue B, Kelly P, Roberts M: We can't afford my chronic illness! The out-of-pocket burden associated with managing chronic obstructive pulmonary disease in western Sydney, Australia. J Health Serv Res Pol 2011, 16:226-231.
• [10]Piette JD, Heisler M, Wagner TH: Problems paying out-of-pocket medication costs among older adults with diabetes. Diabetes Care 2004, 27:384-391.
• [11]Jeon Y-H, Essue B, Jan S: Economic hardship associated with managing chronic illness: a qualitative inquiry. BMC Heal Serv Res 2009, 9:182. BioMed Central Full Text
• [12]Jan S, Essue BM, Leeder SR: Falling through the cracks: the hidden economic burden of chronic illness and disability on Australian households. MJA 2011, 196:1-3.
• [13]Hackett ML, Glozier NG, Jan S: Psychosocial Outcomes in StrokE: the POISE observational stroke study protocol. BMC Neurol 2009., 9 BioMed Central Full Text
• [14]Hackett ML, Glozier NS, Martiniuk AL: Sydney epilepsy incidence study to measure illness consequences: the SESIMIC observational epilepsy study protocol. BMC Neurol 2011., 11 BioMed Central Full Text
• [15]The EQ-5D: a standardised instrument for use as a measure of health outcome. Available from: http://www.euroqol.org/ webcite
• [16]Banks E, Redman S, 45 and Up Study Collaborators: Cohort profile: the 45 and up study. Int J Epidemiol 2008, 5:941-947.
• [17]Australian Bureau of Statistics: 2010 General Social Survey: Summary results. Canberra: ABS. Cat no. 4159.0; 2011.
• [18]Grootaert C, Narayan D, Jones VN: Measuring Social Capital: an integrated questionnaire. Working paper No. 18. Washington: The World Bank; 2004.
• [19]de Vos K, Zaidi MA: Equivalence scale sensitivity of poverty statistics for the member states of the European Community. Review of Income and Wealth 1997, 43:319-333.
• [20]Berki SE: A look at catastrophic medical expenses and the poor. Health Aff (Millwood). 1986, 5:138-145.
• [21]Gordon EJ, Prohaska TR, Sehgal AR: The financial impact of immunosuppressant expenses on new kidney transplant recipients. Clin Transplant 2008, 22:738-748.
• [22]Schoen C, Osborn R, Squires D: How health insurance design affects access to care and costs, by income in eleven countries. Health Aff 2010, 29:2323-2334.
• [23]Hirth RA, Greer SL, Albert JM: Out-Of-Pocket Spending And Medication Adherence Among Dialysis Patients In Twelve Countries. Heal Aff 2008, 27:89-102.
• [24]Hynd A, Roughead EE, Preen DB: The impact of co-payment increases on dispensings of government-subsidised medicines in Australia. Pharmacoepidemiology and Drug Safety 2008, 17:1091-1099.
• [25]Piette JD, Heisler M, Wagner TH: Cost-related medication underuse: do patients with chronic illnesses tell their doctors? Arch Intern Med 2004, 164:1749-1755.
• [26]Liem YS, Bosch JL, Myriam Hunink MG: Preference-based quality of life of patients on renal replacement therapy: a systematic review and meta-analysis. Value Health 2008, 11:733-741.
• [27]Blake C, Codd MB, Cassidy A: Physical function, employment and quality of life in end-stage renal disease. J Nephrol 2000, 13:142-149.