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RESEARCH TRIANGLE PARK, NC – Non-communicable diseases — such as cancer, cardiovascular disease, respiratory disease and diabetes — are responsible for more than 36 million deaths across the globe each year. 14 million of these constitute premature mortality, and 90 percent of these premature deaths take place in low- and middle-income countries.
In response to this crisis, Kenya established an NCD division within its Ministry of Health and launched a five-year National NCD Strategy in 2015 to guide the implementation of interventions that could reduce the mortality from NCDs. Researchers at RTI collaborated with the Ministry of Health and experts from the university and hospital communities to both quantify patient payments for NCD screening, diagnosis and treatment services in both the public and private sectors, as well as determine the ability for patients to pay for services along the continuum of care.
The study, led by Sujha Subramanian, PhD, of RTI International published in the journal PLOS, finds that even in the public sector, most NCD diagnosis and treatment costs represent a substantial economic burden for patients.
“A large proportion of Kenyans do not have health insurance, meaning they have to use savings or borrow money to pay for health care,” says Subramanian. “We cannot reduce the mortality rate of NCDs if patients cannot afford to diagnose and treat their diseases.”
A key methodology of the study involved developing individual frameworks — or treatment pathways — for hypertension, diabetes, cervical and breast cancer, and asthma and chronic obstructive pulmonary disease. Each framework included physician visits, diagnostic procedures, lab tests, medications, and hospitalizations, as appropriate. To quantify patient payments for each procedure, the team used an itemization cost approach using standard economics methods.
Individuals are required to pay for health care services in the public sector in Kenya. While the costs are subsidized, all services require some level of patient contribution. For instance, the costs of medication to treat hypertension can range from $26 to $987 annually.
The study further found that while costs for screening were generally inexpensive, averaging about $4 per test, the costs of diagnostic procedures were substantially higher, particularly those related to cancer and diabetes.
“The high cost of follow up diagnosis procedures may discourage individuals from undergoing screening for NCDs,” Subramanian adds. “We need to prioritize health insurance coverage for screening tests and diagnostic procedures to detect NCDs at an earlier stage when treatment is more effective and less expensive. This is essential to reduce the financial burden on the nation as a whole.”
Subramanian is a leading expert in conducting economic evaluations, specifically related to cancer programs. In the past 15 years, she has directed several program evaluations, including the assessment of the cost and effectiveness of the National Breast and Cervical Cancer Early Detection Program, the Colorectal Cancer Control Program and the National Program of Cancer Registries. For this study, her time was partially funded through a grant from the National Institutes of Health.
