Introduction:
Out-of-pocket expenditures (OOPE) for health care are a major financial burden for Indian households, accounting for USD 3.675 billion annually. Chronic kidney disease patients on maintenance haemodialysis (HD) often face distressing financial costs, which may exacerbate mental health issues, including depression. This study investigates the financial burden of HD, its components, and its association with depression among patients.
Methods:
This cross-sectional study enrolled 52 patients undergoing maintenance HD at Pacific Medical College and Hospital, Udaipur, India. Direct medical, non-medical, and indirect costs were measured. Depression was assessed using the PHQ-9 questionnaire. Catastrophic healthcare expenditure was defined as OOPE exceeding 40% of household income, and distress financing as borrowing money or selling assets for treatment. A multivariable linear regression was conducted to assess the relationship between OOPE for HD and depression.
Results:
The mean age of participants was 50.9 ± 5.5 years, with 61.5% being male. The average monthly OOPE for HD was USD 100.33, of which non-medical and indirect costs comprised USD 75.6. Despite coverage of HD treatment by government health insurance, 80% of patients experienced catastrophic healthcare expenditure, and 50% resorted to distress financing. Mental health screening showed mild depression in 11 patients, moderate in 8, and severe in 3. Multivariable regression analysis demonstrated a significant association between the proportion of household income spent on HD and increased depression (regression coefficient = 0.04).
Conclusions:
This study highlights the substantial financial and emotional burden of maintaining HD. Eighty percent of patients experienced catastrophic healthcare costs, pushing half of the cohort into distress financing. This financial strain was strongly associated with mental health deterioration, particularly depression. There is a critical need for policy interventions to alleviate the economic burden and address the mental health challenges faced by HD patients.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.