title: How are patients managing with the costs of care for chronic kidney disease in Australia? A cross-sectional study.
abstract: BACKGROUND
  Chronic kidney disease (CKD) poses a financial burden on patients and their households. This descriptive study measures the prevalence of economic hardship and out-of-pocket costs in an Australian CKD population.
  
  
  METHODS
  A cross-sectional study of patients receiving care for CKD (stage III-V) in Western Sydney, Australia using a structured questionnaire. Data collection occurred between November 2010 and April 2011. Multivariate analyses assessed the relationships between economic hardship and individual, household and health system characteristics.
  
  
  RESULTS
  The study included 247 prevalent CKD patients. A mean of AUD$907 per three months was paid out-of-pocket resulting in 71% (n=153) of participants experiencing financial catastrophe (out-of-pocket costs exceeding 10% of household income). Fifty-seven percent (n=140) of households reported economic hardship. The adjusted risk factors that decreased the likelihood of hardship included: home ownership (OR: 0.32, 95% CI: 0.14-0.71), access to financial resources (OR: 0.24, 95% CI: 0.11-0.50) and quality of life (OR: 0.12, 95% CI: 0.02-0.56). The factors that increased the likelihood of hardship included if income was negatively impacted by CKD (OR: 4.80, 95% CI: 2.17-10.62) and concessional status (i.e. receiving government support) (OR: 3.09, 95% CI: 1.38-6.91). Out-of-pocket costs and financial catastrophe were not found to be significantly associated with hardship in this analysis.
  
  
  CONCLUSIONS
  This study describes the poorer economic circumstances of households affected by CKD and reinforces the inter-relationships between chronic illness, economic well-being and quality of life for this patient population.
authors.affiliation: The George Institute for Global Health, University of Sydney, Missenden Road, PO Box M201, Sydney, NSW 2050, Australia. beverley.essue@sydney.edu.au
authors.forename: Beverley M
authors.initials: BM
authors.lastname: Essue
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.forename: Jeremy
authors.initials: J
authors.lastname: Chapman
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D011795:Surveys and Questionnaires