Analysis of Patients’ Direct and Indirect Costs at the National Spinal Injury Hospital in Nairobi City County, Kenya
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Date
2025-04
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Kenyatta University
Abstract
Global statistics indicate that based on the extent of spinal cord injury, the first-year cost ranges between $300,000 and $1,000,000. A review of 68 studies by Hadley et.al 2013, revealed that the average cost of an accident varied greatly, from $14 to $17,400. The cost per disability-adjusted life year saved by injury-prevention measures ranged from $10.90 for the installation of speed bumps to $17,000 for campaigns against drunk driving and breathalyser testing in Africa. This study aimed to determine the economic burden of spinal cord injury (SCI) by analyzing patients’ spinal injury costs at the National Spinal Injury Hospital (NSIH) in Nairobi, Kenya. The specific objectives were to: (i) determine the total costs of SCI in the first year of diagnosis and treatment; (ii) analyze variations in costs due to health insurance ownership; (iii) assess cost variations based on the extent of injury; and (iv) examine cost variations based on the employment status of patients. A cross-sectional analytical study was conducted using purposive sampling to select the hospital, the only referral facility for SCI in East Africa. SCI inpatients and outpatients meeting the inclusion criteria were recruited using consecutive sampling until the sample size of 169 was reached. Data were collected through structured questionnaires and secondary data review and analyzed using SPSS version 25. Findings revealed that the average first-year cost of SCI per patient was KSh. 928,326.73, comprising KSh. 187,048 in direct medical costs, KSh. 173,541 in direct non-medical costs, and KSh. 567,738 in indirect productivity losses. Statistical analysis showed no significant difference in total spinal cord injury costs between patients with medical cover and those without medical cover (df=2t=0.6129) or patients with different extents of injury (df=3; P=0.6617), but patients’ employment statuses significantly influenced the total spinal cord injury costs (df=4; P=0.0000). The conclusions were (i) There is no significant difference in the total SCI costs between the SCI patients with medical cover and those without medical cover (ii) There is a significant difference in the total SCI costs amongst SCI patients of different employment statuses (iii) There is no significant difference in the total SCI costs among the SCI patients with different extents of the injury. Recommendations include reducing indirect costs through modern treatment technologies and affirmative actions, promoting the full implementation of the Social Health Insurance Act, providing direct cash transfers to SCI patients, and encouraging employers to support SCI patients with flexible work arrangements and workplace modifications. These findings emphasise the need for targeted interventions to alleviate the economic burden of SCI and enhance patient care at NSIH.
Description
A Thesis Submitted in Partial Fulfilment of the Requirements for the Award of the Degree of Master of Science in Health Management in the School of Health Sciences of Kenyatta University, April 2025.
Supervisor
1. Andre Yitambe
2. Julius K. Korir