02385nas a2200301   4500000000100000008004100001653001000042653001100052653001100063653000900074653001600083653001500099653002000114653002700134653001000161653002000171653002400191653002400215653001000239653001900249100002200268700001100290245009500301300001100396490000600407520165600413022001402069       2013                            d10aAdult10aFemale10aHumans10aMale10aMiddle Aged10aAdolescent10aHospitalization10aKidney Transplantation10aChild10aCost of Illness10aFinancing, Personal10aHealth Expenditures10aIndia10aRenal Dialysis1 aRamachandran Raja1 aJha V.00aKidney transplantation is associated with catastrophic out of pocket expenditure in India.  ae678120 v83 a<p>
Kidney transplantation (KT) is only viable renal replacement option for most patients in India. Most patients do not have health insurance and meet treatment expenditure from their own resources. We prospectively evaluated the expenses associated with KT and its impact on the socioeconomic status of families in a public hospital. All direct and indirect expenses incurred by the patients from the time of diagnosis of chronic kidney disease to KT were recorded. Direct expenses included physician fees, cost of drugs and disposables, dialysis, and expenses on investigations and hospitalization. Indirect expenses included travel, food, stay, and loss of income suffered by the family. Educational dropout and financial loss were also recorded. There were 43 males and 7 females between the ages of 12 and 57 years. Direct expenses ranged from US$ 2,151-23,792 and accounted for two-thirds of the total expenses. Pre-referral hospitalization, dialysis and medication accounted for majority of direct expense. Indirect expenses ranged from US$ 226-15,283. Travel expenses and loss of income accounted for most of indirect expense. About 54%, 8%, and 10% of families suffered from severe, moderate, and some financial crisis respectively. A total of 38 families had job losses, and 1 patient and 12 caregivers dropped out of studies. To conclude, KT is associated with catastrophic out-of-pocket expenditure and pushes a majority of the patients who come for treatment to public hospitals into severe financial crisis. Educational dropout and loss of jobs are other major concerns. Systematic efforts are required to address these issues.
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