Comparative Assessment of Out-of-Pocket Health Expenditure in Haemodialysis and Peritoneal Dialysis Patients

Background: Dialysis is a life-sustaining treatment for patients with end-stage renal disease (ESRD), but it requires high financial costs due to the need for continuous treatment and the associated expenses of medical supplies, equipment, and related care. Objective: This study aims to compare the out-of-pocket (OOP) health expenditure incurred by patients undergoing haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Methods: The data for this observational cross-sectional study were obtained through a survey at two public hospitals, comprising a sample of 220 ESRD patients. In order to compare the OOP health expenditure between two modalities, the Mann-Whitney U test and the chi-square test were employed. Multiple linear-regression analysis was then used to identify the contributing factors associated with the aforementioned OOP expenses. Results: The estimated median monthly OOP health expenditure for HD patients was MYR 388 (interquartile range [IQR: 224-519]), significantly higher than CAPD (MYR 160 [IQR: 100-231]; p < 0.001). Our findings confirm that the choice of dialysis modality significantly affects the OOP health expenditures for dialysis patients MYR 145.73; 95% CI: 75.51-218.15; p < 0.05; 0.001. Additional determinants of OOP health expenditure identified in this study include the interaction between the modality choice and the distance from home to the dialysis centre (MYR 3.39; 95% CI: 0.27-6.66; p < 0.05; 0.022), comorbidity status (MYR 49.51; 95% CI: 9.09-90.77; p < 0.05; 0.031), duration of illness (MYR 4.01; 95% CI: 0.71-7.63; p < 0.05; 0.041), and household income MYR 67.43 (95% CI: 1.71-134.81; p < 0.05; 0.021). Conclusions: This study emphasises the need to improve the training and awareness of CAPD to increase its use, as it requires less travel and lowers OOP expenses. In addition, introducing a travel reimbursement scheme is also recommended to reduce the transportation costs for HD patients.