Economic Costs of Hypertension-diabetes Mellitus Comorbidity in Primary Public Health Facilities in Kiambu County, Kenya

Abstract

Background: Hypertension and raised blood sugar are the most significant risk factors for cardiovascular diseases. In Kenya, they are responsible for much of the disease burden and account for most of the hospital admissions. Also, greatly contributes to catastrophic health expenditures incurred by the patients. For the longest time, the public health system structure was organized in favour of communicable diseases and treatment of chronic conditions was centralized at secondary and tertiary levels of care and occasionally in primary health facilities for emergency response and very basic care. Recently, the government has focused on decentralizing treatment and management of hypertension-diabetes Mellitus comorbidity to primary health facilities to increase access and utilization. However, cost information at this level to guide budget allocation is lacking greatly interfering with service provision since they solely depend on government funding. Objectives: This research sought to estimate the economic costs of hypertension-diabetes Mellitus comorbidity in the public primary health facility. The specific objectives were to estimate the economic cost in level 2 and level 3 health facilities in Kiambu county, Kenya and determine how affordable is the estimated economic unit costs to hypertension-diabetes Mellitus comorbidity patients. Methods: The study adopted a hospital-based analytical cross-sectional design and Activity-Based Costing technique. Further, an ingredient approach was adopted to retrospectively collect prevalence-based data on cases from a health provider perspective and the time horizon for the study was one year, 1st January 2020 and 31st December 2020. The cost ingredients included: personnel remunerations, supervisory staff time, equipment and furniture, essential medicines, non-pharmaceutical products, utility charges, and building space for rental. The study sites were four health facilities in Kiambu county which were selected using a multi-stage sampling technique. Also, a sample of the cases across all the study sites was interviewed to determine the affordability of hypertension-diabetes Mellitus comorbidity. Descriptive statistics, including frequencies and percentages, were used to summarize categorical variables, whereas continuous variables were summarized and presented in means. Further, univariable, and multivariable regression analysis was done to determine variables that added significance to the affordability of hypertension-diabetes Mellitus comorbidity. Results: The unit economic cost for treating and managing hypertension-diabetes Mellitus at a level health 2 facility was estimated at US $ 21.73, US $ 48.91 for a level 3 health facility, and US $ 38 for a primary health care level. Among the cost ingredients, labour across all levels of care was the main cost driver estimated at 48% at level 2 and 59% at level 3. Drugs followed at 13% at level 2 and 28% at level 3. Equipment cost contributed approximately 13% for level 2, and 21% and 13% for level 3 respectively. Non-pharmaceutical and utilities contributed to less than 10% in both levels of care. Logistic regression analyses found drug availability to be associated with the affordability of hypertension-diabetes Mellitus comorbidity. Compared to the unavailability of drugs, public primary health facilities with the availability of drugs is 11.9 times more likely to be affordable to hypertension-diabetes Mellitus comorbidity patients (aOR: 2.48; 95% CI; 5.20- 27.25; P<0.00) holding all factors constant. x Conclusion and recommendation: The study findings reveal the need for the government at all levels to strengthen primary care facilities with trained and adequate staff, enough mix of medical devices and essential drugs, and adequate space to support the delivery of quality care increasing patients’ utilization and affordability. Cost studies on hypertension-diabetes Mellitus comorbidity from a provider perspective are critically missing; no considerable research has been done in Kenya. This calls for more in costing health services, especially referencing the guidelines outlined to make the ‘invisible’ visible to the decision-makers to inform budgeting and resource allocation are achieve the quality care and sustainable development target on NCDs of reducing one-third of premature deaths from NCDs by 2030.