Economic Burden of ESRD to the Malaysian Health Care System

Abstract

Introduction: Prevalence of chronic kidney disease (CKD) in Malaysia is 9.07% of the total population, of which 0.36% are at stage 5 CKD or end-stage renal disease (ESRD). Public-private partnership has improved accessibility of renal replacement therapies (RRT), especially dialysis, in Malaysia, but the economic burden of the existing RRT financing mechanism, which is predominantly provided by the public sector, has never been quantified.

Methods: Primary data were collected through a standardized survey, and secondary data analysis was used to derive estimates of the ESRD expenditure.

Results: Total annual expenditure of ESRD by the public sector has grown 94% within a span of 7 years, from Malaysian Ringgit [MYR] 572 million (US dollars [USD] 405 million, purchasing power parity [PPP] 2010) in 2010 to MYR 1.12 billion (USD 785 million, PPP 2016) in 2016. The total ESRD expenditure in 2010 constituted 2.95% of the public sector's total health expenditure, whereas in 2016, the proportion has increased to 4.2%. Only 6% of ESRD expenditure was spent on renal transplantation, and the remaining 94% was spent on dialysis.

Conclusion: The share of ESRD expenditure in total health expenditure for the public sector is considered substantial given only a small proportion of the population is affected by the disease. The rapid increase in expenditure relative to the national total health expenditure should warrant the relevant authorities about sustainability of the existing financing mechanism of ESRD and the importance to institutionalize more drastic preventive measures.

Keywords: chronic kidney disease; dialysis; end-stage renal disease; microeconomics; national health expenditure; renal transplantation.

Graphical abstract

Figure 1

End-stage renal disease (ESRD) expenditure versus total health expenditure (THE) by the public sector in Malaysia (2010–2016; US dollars purchasing power parity).

Figure 2

Comparison of growth of end-stage renal disease (ESRD) expenditure versus growth of total health expenditure (THE) by the public sector (growth index) and proportion of ESRD expenditure to THE (%) in Malaysia (2010–2016).

Figure 3

Distribution of end-stage renal disease (ESRD) expenditure by the public sector in Malaysia (2010–2016) by category of expenditure (US dollars purchasing power parity). HD, hemodialysis; PD, peritoneal dialysis; RT, renal transplantation.

Figure 4

End-stage renal disease (ESRD) expenditure per capita versus total health expenditure per capita in Malaysia (2010–2016; US dollars [USD] purchasing power parity).

Figure 5

Comparison of growth of end-stage renal disease (ESRD) expenditure per capita versus growth of total health expenditure (THE) per capita (growth index) in Malaysia (2010–2016).

Figure 6

Distribution of renal replacement modalities, by country (2015). Source: United States Renal Data System. Chapter 11: International Comparisons. Available at: https://www.usrds.org/2017/view/v2_11.aspx. Accessed July 23, 2018.

Figure 7

Total health expenditure (THE) per capita by country (2015; US dollars purchasing power parity [USD PPP] 2015). Source: The World Bank. Current health expenditure (% of GDP). Available at: https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS. Accessed July 15, 2018. ESRD, end-stage renal disease.

Figure 8

Prevalence of renal replacement therapy in Malaysia (2007–2016). Source: Malaysian Society of Nephrology. 24th Report of the Malaysian Dialysis and Transplant Registry 2016. Available at: https://www.msn.org.my/nrr/mdtr2016.jsp. Accessed July 24, 2019.