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. 2025 Feb 27;7(5):100987.
doi: 10.1016/j.xkme.2025.100987. eCollection 2025 May.

Quality of Life in Patients with CKD With Catastrophic Health Care Expenditures: A National Study From Thailand

Pornpen Sangthawan  1 , Sarayut L Geater  1 , Pinkaew Klyprayong  2 , Pimwara Tanvejsilp  3 , Sirirat Anutrakulchai  4 , Pongsathorn Gojaseni  5 , Charan Kuhiran  6 , Pichet Lorvinitnun  7 , Kajohnsak Noppakun  8 , Watanyu Parapiboon  9 , Adisorn Pathumarak  2 , Supinda Sirilak  10 , Pleumjit Tankee  11 , Puntapong Taruangsri  12 , Piyamitr Sritara  2 , Nathorn Chaiyakunapruk  13   14 , Chagriya Kitiyakara  2
Affiliations

Quality of Life in Patients with CKD With Catastrophic Health Care Expenditures: A National Study From Thailand

Pornpen Sangthawan et al. Kidney Med. .

Abstract

Rationale & objective: Despite universal health coverage, patients with chronic kidney disease (CKD) in middle-income nations still face financial hardship. Catastrophic health care expenditures (CHEs) serve as a valuable index of patient-derived financial hardship, but few studies have explored the connection of CHE with clinical correlates, especially in patients with CKD. This study aimed to assess the association between CHE and health-related quality of life (HRQoL) in a spectrum of patients with CKD in Thailand.

Study design: A multicenter, nationwide cross-sectional study.

Setting & population: Patients with CKD (stages 3-5 and dialysis) from 11 centers across Thailand.

Exposures: Catastrophic health expenditures.

Outcomes: Health-related quality of life.

Analytical approach: Data on clinical, socioeconomic status, and out-of-pocket expenses were acquired via interviews. The CHE was defined as health care expenditures of at least 40% of the household's capacity to pay. The HRQoL was assessed using the EuroQol-5 Dimensions (EQ5DL) questionnaire. Fractional and multivariable logistic regression models were used to determine the CHE's effect on EQ5DL composite utility scores and each HRQoL dimension.

Results: Of 1,224 patients with CKD, 20% experienced CHE. EuroQol-5 Dimensions utility scores were notably lower in those with CHE (CHE, 0.76 vs No CHE, 0.82, P < 0.001) after adjustments for confounding factors. Differences between CHE and non-CHE appeared in mobility, self-care, and usual activity, with multivariable analysis showing more severe mobility and activity issues in CHE. (adjusted OR [95% CI] in CHE vs non-CHE: mobility: 1.89 [1.23-2.91], P = 0.004; usual activity: 1.82 [1.10-3.02], P = 0.020].

Limitations: Cross-sectional design prevents causal inferences.

Conclusions: Despite health coverage, patients with CKD with financial strain experience reduced quality of life, with pronounced effects on mobility and daily activity. Integrating the assessment of patient-derived financial burden is an essential step into CKD care plans in middle-income countries.

Keywords: Asia; Thailand; catastrophic health care expenditures; chronic kidney disease; dialysis; economic; financial; health inequity; quality of life; renal; socioeconomic; universal health care.

Plain language summary

Patients with chronic kidney disease (CKD) often face substantial out-of-pocket payments for their care. This study aimed to understand how catastrophic health care expenditures (CHE) affect CKD patients' quality of life. CHE occurs when medical costs overwhelm a household's finances. We conducted a nationwide study in Thailand to examine how CHE affects patients with CKD’s well-being, focusing on mobility, daily activities, and emotional health. By analyzing data from patients across different stages of CKD, we found that patients experiencing CHE reported significantly lower quality of life than those without CHE. Our findings identify the need to address financial hardship in CKD care, emphasizing integrated support strategies such as financial planning and assistance to reduce the burden of CHE on daily life.

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Figures

Figure 1
Figure 1
(A) Adjusted utility score according to CHE status. Adjusted for groups of CKD, age, sex, health insurance schemes, diabetes, and cardiovascular disease. (B) Adjusted utility score according to CHE and CKD groups. Adjusted for groups of CKD, age, sex, health insurance schemes, diabetes, and cardiovascular disease. CHE, catastrophic health care expenditures; CKD, chronic kidney disease.
Figure 2
Figure 2
The percentage of patients with severe impairment in each dimension of EQ5D5L according to CHE status. Adjusted with groups of CKD, age, sex, health insurance schemes, diabetes, and cardiovascular disease. CHE, catastrophic health expenditure; CKD, chronic kidney disease. ∗P < 0.05,
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