Catastrophic health expenditures and economic burden of end-stage kidney disease among patients receiving hemodialysis or conservative care in Lao PDR
7 affiliations
- 1Unit for Health Evidence and Policy (UHEP), Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Vientiane, Lao PDR
- 2Department of Natural and Social Sciences, Faculty of Medicine, University of Health Sciences, Vientiane, Lao PDR
- 3Health Intervention and Technology Assessment Program Foundation (HITAP), Nonthaburi, Thailand
- 4Department of Nephrology, Mittaphab Hospital, Vientiane, Lao PDR
- 5Microbiology Laboratory, Lao-Oxford Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao PDR
- 6Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- 7Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore, Singapore
Abstract
In Lao PDR, limited health insurance coverage poses significant challenges for patients requiring renal replacement therapy (RRT). However, the economic burden of end-stage kidney disease (ESKD), particularly for patients receiving hemodialysis compared with conservative care, remains poorly documented. We conducted a cross-sectional, prevalence-based, costing study, using consecutive sampling of ESKD patients receiving hemodialysis or conservative care at two tertiary hospitals in Lao PDR in 2025. A total of 117 patients were enrolled. Direct medical, direct non-medical, and caregiver productivity costs were collected through hospital surveys and patient interviews and annualized. National economic burden was extrapolated using estimated ESKD prevalence and assumed treatment distribution. The projected annual economic burden was estimated at 2.1 trillion kip (≈USD105 million) in 2025, based on an expert-informed treatment distribution used for national extrapolation. On average, this was approximately 280 million Kip/patient (≈USD13,692), largely driven by medical expenses. The average annual economic cost, comprised of medical, non-medical, and productivity costs, was 332 million Kip/year for hemodialysis patients, exceeding their average annual income (62 million Kip) by more than fivefold. Using 40% of total household income as an unadjusted proxy for capacity-to-pay, 83% of hemodialysis households and 63% of conservative care households exceeded the threshold, despite limited formal financial protection. Caregivers also experienced financial burdens through income loss and additional expenditures. Conservative care patients, though incurring lower costs, tended to be from economically vulnerable populations. ESKD imposes a considerable economic burden on patients and households in Lao PDR, particularly for those receiving hemodialysis in a setting with limited financial protection. These findings suggest that expanding health insurance coverage for ESKD patients and subsidizing non-medical costs are urgently needed.
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BibTeX
@article{soukavong2026catastrophic,
title = {{Catastrophic health expenditures and economic burden of end-stage kidney disease among patients receiving hemodialysis or conservative care in Lao PDR}},
author = {Mick Soukavong and Manit Sittimart and Thidachanh Soukhasem and Somvai Singhaxaiyaseng and Chanmaly Keomany and Oulai Oudommixay and Sysavanh Phommachanh and Elizabeth A. Ashley and Yot Teerawattananon and Mayfong MayxaY},
journal = {PLOS Global Public Health},
year = {2026},
month = nov,
doi = {10.1371/journal.pgph.0007532},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007532},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Catastrophic health expenditures and economic burden of end-stage kidney disease among patients receiving hemodialysis or conservative care in Lao PDR
AU - Mick Soukavong
AU - Manit Sittimart
AU - Thidachanh Soukhasem
AU - Somvai Singhaxaiyaseng
AU - Chanmaly Keomany
AU - Oulai Oudommixay
AU - Sysavanh Phommachanh
AU - Elizabeth A. Ashley
AU - Yot Teerawattananon
AU - Mayfong MayxaY
PY - 2026
DA - 2026/11/05
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007532
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007532
AB - In Lao PDR, limited health insurance coverage poses significant challenges for patients requiring renal replacement therapy (RRT). However, the economic burden of end-stage kidney disease (ESKD), particularly for patients receiving hemodialysis compared with conservative care, remains poorly documented. We conducted a cross-sectional, prevalence-based, costing study, using consecutive sampling of ESKD patients receiving hemodialysis or conservative care at two tertiary hospitals in Lao PDR in 2025. A total of 117 patients were enrolled. Direct medical, direct non-medical, and caregiver productivity costs were collected through hospital surveys and patient interviews and annualized. National economic burden was extrapolated using estimated ESKD prevalence and assumed treatment distribution. The projected annual economic burden was estimated at 2.1 trillion kip (≈USD105 million) in 2025, based on an expert-informed treatment distribution used for national extrapolation. On average, this was approximately 280 million Kip/patient (≈USD13,692), largely driven by medical expenses. The average annual economic cost, comprised of medical, non-medical, and productivity costs, was 332 million Kip/year for hemodialysis patients, exceeding their average annual income (62 million Kip) by more than fivefold. Using 40% of total household income as an unadjusted proxy for capacity-to-pay, 83% of hemodialysis households and 63% of conservative care households exceeded the threshold, despite limited formal financial protection. Caregivers also experienced financial burdens through income loss and additional expenditures. Conservative care patients, though incurring lower costs, tended to be from economically vulnerable populations. ESKD imposes a considerable economic burden on patients and households in Lao PDR, particularly for those receiving hemodialysis in a setting with limited financial protection. These findings suggest that expanding health insurance coverage for ESKD patients and subsidizing non-medical costs are urgently needed.
SN - 2767-3375
ER -