Catastrophic health expenditures and economic burden of end-stage kidney disease among patients receiving hemodialysis or conservative care in Lao PDR

In Lao PDR, limited health insurance coverage poses significant challenges for patients requiring renal replacement therapy (RRT). However, the economic burden of end-stage kidney disease (ESKD), particularly for patients receiving hemodialysis compared with conservative care, remains poorly documented. We conducted a cross-sectional, prevalence-based, costing study, using consecutive sampling of ESKD patients receiving hemodialysis or conservative care at two tertiary hospitals in Lao PDR in 2025. A total of 117 patients were enrolled. Direct medical, direct non-medical, and caregiver productivity costs were collected through hospital surveys and patient interviews and annualized. National economic burden was extrapolated using estimated ESKD prevalence and assumed treatment distribution. The projected annual economic burden was estimated at 2.1 trillion kip (≈USD105 million) in 2025, based on an expert-informed treatment distribution used for national extrapolation. On average, this was approximately 280 million Kip/patient (≈USD13,692), largely driven by medical expenses. The average annual economic cost, comprised of medical, non-medical, and productivity costs, was 332 million Kip/year for hemodialysis patients, exceeding their average annual income (62 million Kip) by more than fivefold. Using 40% of total household income as an unadjusted proxy for capacity-to-pay, 83% of hemodialysis households and 63% of conservative care households exceeded the threshold, despite limited formal financial protection. Caregivers also experienced financial burdens through income loss and additional expenditures. Conservative care patients, though incurring lower costs, tended to be from economically vulnerable populations. ESKD imposes a considerable economic burden on patients and households in Lao PDR, particularly for those receiving hemodialysis in a setting with limited financial protection. These findings suggest that expanding health insurance coverage for ESKD patients and subsidizing non-medical costs are urgently needed.