A retrospective cohort study on the cost-effectiveness analysis of kidney transplantation compared to dialysis in Cameroon: evidence for policy

Abstract

Introduction:chronic kidney disease affects one in ten adults in Cameroon. Haemodialysis was the only renal replacement therapy (for adults) in Cameroon and its sub-region until November 10, 2021. Thereafter through May 2022, the Yaoundé General Hospital successfully completed four living-donor kidney transplants. This paper examines policy implications. Methods: medical records of cohorts of kidney failure patients who started haemodialysis at Yaoundé General Hospital in 2012 (n=106) and 2017 (n=118) were abstracted retrospectively through 2021 and their survival analyzed with Microsoft Excel and Kaplan-Meier curves. Using hospital data, the literature, and price indexes, the annual medical cost per patient of dialysis and living-donor kidney transplantation in 2022 prices was derived. Results: the 9.5-year survival rate for the 2012 cohort was 11% and the 5-year rate for the 2017 cohort was 18%. Annual haemodialysis cost per patient averaged $17,681 (26.5% from households and 73.5% from government). Initial transplantation costs averaged $10,530 per patient, all borne by the government. Under the brand-drug option, first-year transplantation follow-up costs $19,070 (4% for laboratory and 96% for drugs). Conclusion: annually, haemodialysis in Cameroon costs per patient 12 times the country's average income ($1,537), driven especially by the costs of equipment purchase, maintenance, and consumables. Cameroon's initial cost of transplantation is lower than in other African countries. Generic drugs could lower annual followup costs by 89%. If Cameroon could achieve longterm survival with generic drugs after kidney transplantation, that modality would become a reasonable option for selected kidney failure patients (e.g. younger and without other comorbidities).