Dialysis dilemma: How to ease the costly burden on kidney patients?

Masud Rana, a kidney patient from Dhaka, has been undergoing dialysis three times a week since 2013. The treatment costs him about Tk35,000 a month, putting a heavy strain on his finances.

As a salesman in a private company, Masud finds it increasingly difficult to bear the expenses. To make ends meet, he was forced to sell land after years of treatment. He currently relies on help from relatives, friends and colleagues to be able to afford his dialysis sessions.

"In Dhaka, it's difficult to afford dialysis treatment along with paying rent and my children's education expenses," Masud told TBS. 

"I rely on donations for dialysis and avoid borrowing money because I can't repay it. After each session, I worry about being able to afford the next one. If I miss dialysis for three days a week, fluid builds up in my body and I become very sick."

Masud's story is not unique. 

Infographic: TBS

Zahid, another kidney patient, spends Tk25,000 a month on dialysis. In the past four years, Zahid, who recently graduated with an honours degree, has had to sell his house to cover treatment costs. 

Now living with his mother at his sister's house, Zahid relies on his sister's support and other donations to pay for his dialysis and medicine.

Like Masud and Zahid, 92% of families with members needing kidney dialysis in Bangladesh struggle financially to cover treatment costs, according to a study by the Bangladesh Institute of Development Studies (BIDS).

Health experts suggest that kidney patients who need dialysis should be included in a safety net programme to make treatment more affordable. The government could allocate additional funds to protect patients from financial shocks. Additionally, dialysis treatment should be covered by insurance to reduce costs.

The study, titled "Out of Pocket Costs of Kidney Dialysis in Bangladesh," was presented at the "Annual BIDS Conference on Development 2024" in Dhaka yesterday.

The findings reveal that the average monthly cost of kidney dialysis in Bangladesh is Tk46,426, with expenses ranging from Tk6,690 to Tk210,000. These high costs place a heavy burden on families, with over 92% of them facing financial hardship because of the expensive treatment.

Abdur Razzaque Sarkar, a research fellow at BIDS, presented the study's key findings during a session on education and health. He explained that annual out-of-pocket costs for dialysis can range from Tk80,280 to Tk25.2 lakh.

Sarkar urged the government to set up dialysis facilities in district hospitals and subsidise private hospital services to make treatment more affordable. "Dialysis facilities must be made affordable for resource-poor households," he said.

He also suggested including kidney dialysis patients in a safety net programme, providing insurance coverage for dialysis, having state-owned companies produce costly treatment drugs and increasing government budget allocations to protect families from the financial burden of high treatment costs.

The study showed that nearly 0.8 million people in Bangladesh need dialysis, but only 30,000 can access treatment due to financial and logistical challenges.

The research found that dialysis fees (35.3%) and medication costs (23%) are the biggest contributors to treatment expenses, with medical costs making up 78.79% of the total expenditure.

Doctors said that dialysis is crucial for patients whose kidney function has dropped to 10-15%. It is a life-sustaining treatment that removes waste and excess fluid from the blood.

The study also showed that nearly 90% of households with kidney dialysis patients face catastrophic health expenses, with about 19.5% of patients receiving fewer dialysis sessions than recommended. 

Low-income families are the hardest hit, with 30.21% of the poorest patients getting less treatment due to the high costs involved.

The study, based on a survey of 477 hospitalised patients from public, private and NGO healthcare facilities in November and December 2023, calls for urgent reforms.

Dr Mohib Ullah Khondoker, director of Gonoshasthaya Kendra, told TBS that most countries subsidise dialysis due to its high cost. Many families are financially devastated by the continuous need for dialysis.

"Our hospital provides dialysis at the lowest cost, but there are still many patients who need dialysis three times a week and cannot afford even one session. Dialysis should be treated as a special service, with the government taking responsibility for it. The government must act to reduce the current cost of dialysis and lower the prices of dialysis tubes and medicines," he said.