Out-of-pocket costs and catastrophic health expenditure among hospitalised patients with heart failure in northern Tanzania, May–October 2024: a cross-sectional study

Objectives To quantify out-of-pocket (OOP) costs and catastrophic health expenditure (CHE) among patients hospitalised with heart failure (HF) and to identify factors associated with CHE during a single index admission in northern Tanzania. Design Prospective cross-sectional study. Setting Medical ward of Kilimanjaro Christian Medical Centre, a tertiary referral hospital in northern Tanzania, from 1 May to 31 October 2024. Participants Consecutive patients aged 14 years or older admitted with acute decompensated HF diagnosed using Framingham criteria. Of 309 eligible patients, 290 completed the study and were included in the analysis. Main outcome measures The primary outcome was CHE, defined as OOP spending exceeding 40% of household non-food expenditure for the index hospitalisation. Secondary outcomes included total inpatient OOP cost and cost distribution by category. Factors associated with CHE were assessed using multivariable logistic regression. Results Among 290 hospitalised patients with HF, 201 (69.3%) experienced CHE during the index admission. The median total cost of hospitalisation was US$229 (IQR 155–405), and the median OOP payment was US$192 (IQR 39–360). Diagnostic investigations accounted for the largest share of OOP expenditure. In multivariable analysis, family income US$≤115 (adjusted OR (aOR) 10.0, 95% CI 4.3 to 23.0) and lack of health insurance (aOR 22.9, 95% CI 9.3 to 56.1) were strongly associated with CHE. Other independent associated factors were non-use of mineralocorticoid receptor antagonists before admission (aOR 4.1, 95% CI 1.5 to 11.1), reduced left ventricular ejection fraction (aOR 3.1, 95% CI 1.2 to 8.0) and length of stay >7 days (aOR 4.1, 95% CI 1.7 to 10.0). Conclusions CHE was common among patients hospitalised with HF in northern Tanzania during a single admission, driven mainly by diagnostic costs and limited financial protection. Expanding insurance coverage, improving access to guideline-directed HF therapy and reducing patient payment for essential diagnostics may lessen the financial burden of HF care.