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Risk of Catastrophic Health Expenditure in Rwandan Surgical Patients with Peritonitis

World Journal of Surgery volume 42, pages 1603–1609 (2018)Cite this article

Abstract

Background

Surgical procedures are cost-effective compared with various medical and public health interventions. While peritonitis often requires surgery, little is known regarding the associated costs, particularly in low- and middle-income countries. The aim of this study was to determine in-hospital charges for patients with peritonitis and if patients are at risk of catastrophic health expenditure.

Methods

As part of a larger study examining the epidemiology and outcomes of patients with peritonitis at a referral hospital in Rwanda, patients undergoing operation for peritonitis were enrolled and hospital charges were examined. The primary outcome was the percentage of patients at risk for catastrophic health expenditure. Logistic regression was used to determine the association of various factors with risk for catastrophic health expenditure.

Results

Over a 6-month period, 280 patients underwent operation for peritonitis. In-hospital charges were available for 245 patients. A total of 240 (98%) patients had health insurance. Median total hospital charges were 308.1 USD, and the median amount paid by patients was 26.9 USD. Thirty-three (14%) patients were at risk of catastrophic health expenditure based on direct medical expenses. Estimating out-of-pocket non-medical expenses, 68 (28%) patients were at risk of catastrophic health expenditure. Unplanned reoperation was associated with increased risk of catastrophic health expenditure (p < 0.001), whereas patients with community-based health insurance had decreased risk of catastrophic health expenditure (p < 0.001).

Conclusions

The median hospital charges paid out-of-pocket by patients with health insurance were small in relation to total charges. A significant number of patients with peritonitis are at risk of catastrophic health expenditure.

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Author information

Affiliations

  1. University Teaching Hospital of Kigali, Kigali, Rwanda

    J. L. Rickard

  2. Department of Surgery, University of Minnesota, 516 Delaware St SE, 11-145E, Minneapolis, MN, 55455, USA

    J. L. Rickard

  3. University Teaching Hospital of Butare, Butare, Rwanda

    C. Ngarambe & L. Ndayizeye

  4. University of Southern California, San Diego, CA, USA

    B. Smart

  5. University of Gitwe, Gitwe, Rwanda

    J. P. Majyambere

  6. Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA

    R. Riviello

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  1. J. L. Rickard
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  2. C. Ngarambe
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  3. L. Ndayizeye
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  4. B. Smart
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  5. J. P. Majyambere
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  6. R. Riviello
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Correspondence to J. L. Rickard.

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Rickard, J.L., Ngarambe, C., Ndayizeye, L. et al. Risk of Catastrophic Health Expenditure in Rwandan Surgical Patients with Peritonitis. World J Surg 42, 1603–1609 (2018). https://doi.org/10.1007/s00268-017-4368-x

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  • DOI: https://doi.org/10.1007/s00268-017-4368-x