Financial implications of anemia management in anaemic chronic kidney disease patients in South-South Nigeria.

Abstract

Anaemia is a common occurrence in Chronic Kidney Disease (CKD) patients being almost universal in End Stage Renal Disease (ESRD) patients. Modern management of anaemia involve the use of Erythropoiesis Stimulating Agents (ESA’s) and parenteral iron. It is a highly effective therapy, but its use in our environment seems to be largely hampered by costs. While studies have shown that the costs are high, few or no studies have addressed the actual costs in Naira.
Objectives- To assess the cost implications of anaemia management using ESA’s and parenteral iron and vitamins at the University ofBenin Teaching Hospital, a tertiary health care centre in South-South Nigeria.
Methods-Costs of investigating a patient for anaemia were obtained from the revenue unit of the laboratory. Costs of purchase of erythropoietin and iron sucrose, syringes, needles, folic acid and other medications were obtained from the revenue unit of the pharmacy department of the University of Benin Teaching Hospital. These costs were evaluated using the standard prescription for EPO use in renal disease patients. The total costs were compared to the salary structure of the Edo state civil service, and the CONTISS salary structure of the Federal Government of Nigeria. The prevalent number of patients using EPO and Iron sucrose were also evaluated. 
Results- Average costs of Erythropoietin at 4000iu 2 times weekly and iron sucrose 200mg weekly and baseline investigations was approximately₦40,300 in the first week and ₦29,500 every subsequent week. This amounts to ₦128,800 in the first one month and ₦118,000 per month or ₦1,426,800 for the first year then ₦1,416,000 (one million four hundred and sixteen thousand naira) yearly. This may account for why only a few of our patients, 8(4.73%) are using EPO and parenteral iron at the point of this analysis.
Conclusion- The cost of management of anaemia with erythropoietin is very expensive and out of reach for most Nigerians. This is most likely the reason why EPO use has not been widespread among our CKD patients. There is need for a review of pricing to enable more CKD patients to have access to EPO as only 23.08% of our CKD patients are currently on EPO management irregularly and only 4.73% of our patients are on Iron Sucrose and erythropoietin.