Willingness to Accept and Pay for Kidney Transplant among Chronic Kidney Disease Patients Attending Korle-Bu Teaching Hospital

Abstract

Background The treatment of end stage renal disease is renal replacement therapy in the form of dialysis and kidney transplantation. The preferred treatment of choice is kidney transplantation which is absent in most African countries. Kidney transplantation is at its infancy in Ghana. This study seeks to determine how much patients are willing to pay for kidney transplant and whether this treatment is an acceptable option. Aim The aim of the study was to assess Chronic Kidney Disease (CKD) patients’ willingness to accept and pay for kidney transplantation as a treatment option for end stage renal disease in Ghana. Methods This cross-sectional study was conducted in Korle-Bu Teaching Hospital outpatient and dialysis units among CKD patients who are not on dialysis and those on dialysis. A consecutive sampling approach was used to recruit 342 consented patients. Structured questionnaire was used to obtain information on demographic, socio-economic, knowledge about transplant, perception of transplantation and contingency valuation (CV) method was used to assess willingness to pay for kidney transplantation. Standardized research instrument (INSPIRIT) was used to assess patients’ religiosity/spirituality. Willingness to pay and accept was reported in terms of proportions and logistic regression model was used to determine the significant predictors of willingness to pay. Results Nearly half of the participants (46.5%, 118/342) rated their knowledge level of kidney transplant below average and approximately 67% (230/342) of study participants were willing to accept a kidney transplantation. Overall, of every ten selected study participants, only about three (26.3%, 95%CI: 21.7 - 31.3%) of them were willing to pay for a kidney transplant at the current going price or more (≥ GHS 86,000). More than half (55.0%, 188/342) of the patients were willing to pay below GHS 20,000 to undertake a kidney transplant. One-fifth (21.3%, 73/342) of the patients were willing to pay the highest price quoted GHS106,000 to undergo the transplant. Among those who are willing to accept, (29.13%, 67) were willing to pay. From the logistic regression model, patients in higher wealth quintile and those not having health insurance were willing to pay for kidney transplant (aOR: 12.33, 95%CI: 2.32 - 65.51 vs aOR: 2.85, 95%CI: 1.09 - 7.45). Conclusion The overall willingness to pay for kidney transplant is low among chronic kidney disease patients attending Korle-Bu Teaching Hospital. The main predictors of willingness to pay were the wealth quintile and insurance status. In order to develop a sustainable kidney transplant programme, there should be alternative sources of funds including insurance remittances, government subsidies, support from individuals and non-governmental organizations.