Patient costs of diabetes mellitus care in public health care facilities in Kenya

Objective: To estimate the direct and indirect costs of diabetes mellitus care at five public health facilities in Kenya.

Methods: We conducted a cross-sectional study in two counties and interviewed diabetes patients who were aged 18 years and above. A total of 163 patients seeking diabetes care at five public facilities were interviewed and information on care seeking and the associated costs was obtained using the cost-of-illness approach. Medicines and user charges were classified as direct healthcare costs while expenses on transport, food, and accommodation were classified as direct non-healthcare costs. Productivity losses due to diabetes were classified as indirect costs. We computed annual direct and indirect costs borne by these patients.

Results: More than half (57.7%) of sampled patients had hypertension comorbidity. Overall, the mean annual direct patient cost was KES 53,907 (95% CI, 43,625.4-64,188.6) (US$ 528.5 (95% CI, 427.7-629.3)). Medicines accounted for 52.4%, transport 22.6%, user charges 17.5% and food 7.5% of total direct costs. Overall mean annual indirect cost was KES 23,174 (95% CI, 20,910-25,438.8) (US$ 227.2 (95% CI, 205-249.4)). Patients reporting hypertension comorbidity incurred higher costs compared to diabetes only patients. The incidence of catastrophic costs was 63.1% (95% CI, 55.7,70.7) and increased to 75.4% (95% CI, 68.3,82.1) when transport costs were included.

Conclusion: There are substantial direct and indirect costs borne by diabetic patients in seeking care from public facilities in Kenya. High incidence of catastrophic costs suggest diabetes services are unaffordable to majority of diabetic patients and illustrate the urgent need to improve financial risk protection to ensure access to care.