Health and Financial Burden of Kidney Dialysis in Bangladesh

Prevention of chronic kidney disease (CKD) becomes increasingly important in low- and middle-income countries. In South Asian settings hemodialysis is frequently utilized than peritoneal dialysis due to limited services.  In the South Asian context, only 30% of the total patients with kidney failure can afford dialysis (Divyaveer et al., 2021). It was observed that, dialysis for kidney failure patients in low-and middle-income countries (LMICs) is very expensive around US$ 3,424 to US$ 42,785 per year for hemodialysis (HD) and US$ 7, 974 to US$ 47, 971 for peritoneal dialysis (Hosen et al., 2020). In Bangladesh, around 0.8 million kidney failure patients require dialysis, but only 30,000 are able to receive it due to lack of availability and financial capability (Nawaz Farhin, 2017). A systematic literature focusing on Asian countries observed that the overall pooled prevalence of CKD among Bangladeshi adults was 17.3% (Hasan et al., 2018). The prevalence of CKD was higher among elderly people aged more than 40 years (16.5%) while it was 10.7% among the population ages between 25 years and 40 years (Huda et al., 2012). It was observed that a limited number of specialized kidney dialysis centers are available and all of them are mostly located within the catchment area of big cities like Dhaka, Chottogram etc. Patients often need to travel long distances in order to access this crucial treatment, and long-distance travel could potentially exacerbate existing conditions. Although a bunch of literature indicated the prevalence and associated factors of CKD, the studies focusing on the financial burden and affordability of kidney dialysis is scarce in Bangladesh. It is important to estimate and calculate the economic burden of kidney dialysis not only for patients and their families but also for the healthcare system and societal perspective. This study is planned to fill this knowledge gap in this context. This study will identify the out-of-pocket costs associated with healthcare utilization, such as prevention, diagnosis, treatment and medication. Indeed, the prevention strategies and affordability issues will become increasingly important in resource-poor setting countries like Bangladesh to Universal Health Coverage in 2032. 

The overall of this study is to estimate the health and economic burden of kidney dialysis patients in Bangladesh. Examining the economic dimensions of the disease through this research will provide important evidence for making socioeconomic policies related to kidney dialysis and similar devastating NCDs. 

The specific objectives of the study are:

1. To assess the annual out-of-pocket cost of kidney dialysis from households’ perspective  

2. To assess the catastrophic health care expenditure and financial distress of kidney dialysis among Bangladeshi households

3. To assess the health-related quality of life of CKD patients using EQ-5D-5L

Study Director:

Dr. Abdur Razzaque Sarker, 

Population Studies Division