Cost analysis of dialysis treatment costs in Africa

The variable costs of dialysis treatment across the whole continent of Africa is wide, with end treatment costs ranging from $25.00 USD (subsidised) to over $250.00 USD in some cases even higher.

Why is the huge variation?

Where the costs are lowest, it is where the highest density of population is as a whole and translates to high numbers of dialysis patients. In these countries the local governments have taken steps to ensure costs are at the lowest. By taking a top down approach on cost of treatment its has ensured a steady flow of consumables as these are government supported figures, as well as support for local industries to produce the items required during treatment, which are bulky to ship form abroad and mainly water based. This localised production of bulky items and other simpler tubing assembly plants has ensured a local industry being supported as well as lower end cost of items needed.

The countries which have been able to benefit from the above also have access to shipping ports and this limits the few locations where the economies of scale can have a positive impact as well as lower import cost of raw materials where needed.

Whereas the majority of countries in Africa do not have some or all of these attributes, which leads them to a total import status of completed items. The major part of the cost per item goes towards the transportation from sea and inland transport cost.

This is not to say that the initial consumable prices are low.

The second part of the cost equation is the way dialysis centres are set up and how the supply contracts are agreed. An area where details don’t easily come to light in regard to the actual per treatment cost. The contracts are so deeply written and intertwined with support levels, and other related consumables to keep the systems functioning and running. The end user inevitably has no option then to choose from the major suppliers in their country. This in turn ensures the supply company negotiates at the highest price possible for the benefit of their shareholders and thus ensures the cost of dialysis treatment remains unbearably high.

Considering that the average income per person in Africa (The average per capita income (excluding South Africa), inflation-adjusted, is $315, lower than it was in 1960. Africa's population is more than twice that of the U.S., but its total income is not much more than Belgium's Quoted from Forbes.).

A person diagnosed with Chronic Kidney Disease (CKD) where a persons kidney function is around 10-15% effective. They have to undertake dialysis treatment for the rest of their lives if a transplant is not possible. Across Africa the transplant levels remain extremely low compared to more developed countries. The normal recommended HD (Hemodialysis treatment) is 3 per week if not higher in developed countries. In Africa this is 2 treatments per week and as low as 1 per week.

The reduction is due to the overbearing costs of the treatment where the cost burden is shared amongst the families of the person who has CKD. This means the extended family works to keep a single person alive. This is a common scenario in many countries, and for many they have to add the cost of travel to the dialysis clinic/hospital as additional cost or stay closer to the city or town where treatment can be received.

In some cases we have witnessed families living apart in order to keep someone alive.

If a person travels for treatment they usually have to endure a 2-4 hour road journey and then another 4-5 hour treatment session, to then return back home with another 2-4 hour road journey.

In countries where the infrastructure and healthcare support is developed, patients do no more than a 1 hour travel in more comfortable circumstances, and have a shorter treatment due to more advanced machines as well as lower or no cost for the treatment. Greater support for aftercare as well as nutritional support etc etc.

From the outline descriptions it is easy to see that the dice is loaded heavily against the patient in Africa with kidney failure.

So what are the solutions to change the parameters?

Using independent supply sources for consumables.

Seeking contracts which are fairer and provided by independent companies who are not tied to major manufacturers.

Being open to the variety of alternative solutions and cost saving options which can improve treatment for patients as well as reduce costs.