Real-World Cost of Automated Red Blood Cell Exchange for Sickle Cell Disease in Kenya: A Cost-Reimbursement Gap Analysis From a Public Sector Perspective
Author(s)
Ghofrane KAMOUN, PharmD1, Leda Sweerts, MBA1, Nathan Mulure, MD2, Hiram Mwangi, MD2, Anna Yudina-Reznikau, MD1.
1Terumo BCT Europe N.V., Zaventem, Belgium, 2Terumo BCT Kenya Ltd., Nairobi, Kenya.
1Terumo BCT Europe N.V., Zaventem, Belgium, 2Terumo BCT Kenya Ltd., Nairobi, Kenya.
OBJECTIVES: Sickle Cell Disease (SCD) is a high-burden condition in Kenya, particularly among children and young adults in western and coastal regions. In response, Kenya’s 2023 Social Health Insurance Act introduced the Social Health Insurance Fund (SHIF), which now reimburses automated red blood cell exchange (aRBCX) at a fixed tariff of KES70,000 per session. This study aimed to estimate the actual per-procedure cost of aRBCX in Kenya’s public sector and compare it with the current SHIF allocated reimbursement.
METHODS: A micro-costing analysis was conducted from the public provider perspective, capturing all direct cost inputs associated with aRBCX delivery. Personnel costs were based on hourly wages and time spent per procedure. Capital equipment was amortised over a 10-year period. Consumables, venous access, packed RBCs (pRBCs), and additional solutions, including anticoagulants and calcium gluconate, were also considered Cost data in Kenyan Shillings were gathered from hospital procurement records, national wage scales, and supplier quotes, with total costs compared to the SHIF ceiling.
RESULTS: The estimated mean cost per aRBCX session ranged from KES 130,000 to KES 150,000, depending on pRBCs usage. Blood products constituted the largest cost component, ranging from KES 54,000 to KES 72,000 (45-51%), followed by consumables, estimated at KES36,700 (25%), and venous access with an average cost of KES25,200 (17%). Compared to the SHIF reimbursement ceiling of KES 70,000, the cost gap ranged from KES 59,050 to KES 77,050 per session, indicating an under-reimbursement of 46-52%.
CONCLUSIONS: The analysis revealed that current SHIF reimbursement significantly underestimates the actual cost of aRBCX, posing risks to service sustainability within the public sector. This underscores the need for policymakers and payers to revisit the reimbursement level or identify subsidies to better align with actual costs. Bridging this mismatch is crucial to ensure that SCD patients can receive lifesaving treatments without financial barriers or straining hospital resources.
METHODS: A micro-costing analysis was conducted from the public provider perspective, capturing all direct cost inputs associated with aRBCX delivery. Personnel costs were based on hourly wages and time spent per procedure. Capital equipment was amortised over a 10-year period. Consumables, venous access, packed RBCs (pRBCs), and additional solutions, including anticoagulants and calcium gluconate, were also considered Cost data in Kenyan Shillings were gathered from hospital procurement records, national wage scales, and supplier quotes, with total costs compared to the SHIF ceiling.
RESULTS: The estimated mean cost per aRBCX session ranged from KES 130,000 to KES 150,000, depending on pRBCs usage. Blood products constituted the largest cost component, ranging from KES 54,000 to KES 72,000 (45-51%), followed by consumables, estimated at KES36,700 (25%), and venous access with an average cost of KES25,200 (17%). Compared to the SHIF reimbursement ceiling of KES 70,000, the cost gap ranged from KES 59,050 to KES 77,050 per session, indicating an under-reimbursement of 46-52%.
CONCLUSIONS: The analysis revealed that current SHIF reimbursement significantly underestimates the actual cost of aRBCX, posing risks to service sustainability within the public sector. This underscores the need for policymakers and payers to revisit the reimbursement level or identify subsidies to better align with actual costs. Bridging this mismatch is crucial to ensure that SCD patients can receive lifesaving treatments without financial barriers or straining hospital resources.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE633
Topic
Economic Evaluation, Health Policy & Regulatory, Real World Data & Information Systems
Disease
Rare & Orphan Diseases, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)